Suomen sivusto, jossa voit ostaa halvalla ja laadukas Viagra http://osta-apteekki.com/ toimitus kaikkialle maailmaan.

Yritti äskettäin viagra, se toimii erittäin tehokkaasti)) Ostaa Internetin kautta täällä cialis Myös ostaa levitra oikeudenkäynti, vaikutus on silmiinpistävää.

Does this child have asthma

Jefferson County Public Schools Health Services
Primary Care Provider Authorization (PCP): Asthma/Allergy (Side One)
2013-2014 School Year
Student Name: ______________________________ Date of Birth: _____________ School: _____________________________
Does this child have ALLERGIC REACTIONS? __ YES __ NO
Does this child have ASTHMA? ____ YES ____ NO
What things cause this student’s allergic reaction? Please list.
__ Medications _____________________
What things may bring on this child’s asthma?
__ Stinging Insects __________________
__ Pollens __ Dust __ Animals __ Exercise __ Foods
__ Other ___________________________
__ Illness __ Other_________________________________
FOOD ALLERGY? __ YES __ NO
Asthma SYMPTOMS may include: Coughing, Shortness of Breath,
Please list any food allergies: _________________________________________
and Wheezing. Please list any other symptoms specific for this child:
Any food not to be served to student: __________________________________
_________________________________________________
Is student Lactose Intolerant? __ YES __ NO
*Please refer to Emergency Plan of Action on Side Two for symptoms

Nutritional info available at

indicating an emergency asthma situation.
you may call 485-
3186 for more information.
Asthma Medications AT SCHOOL:
Order will be for current school year unless otherwise indicated.
SYMPTOMS of the allergic reaction for this child:
__Itching/Swelling of Lips, Mouth, Tongue or Throat
__ Albuterol (Ventolin, Proventil, ProAir), Xopenex, Maxair (Circle)
__Hives/Rash __Nausea/Vomiting/Stomach Cramps
__ 2 puffs every 4-6 hours as needed
__Shortness of Breath __Wheezing __Coughing
__ _____ puffs every ______ hours as needed
__Dizziness __Unconsciousness __ Other __________________________
__ 2 puffs ______ minutes prior to exercise
__ Nebulizer every 4-6 hours as needed_________________
Medications AT SCHOOL:
Order will be for current school year unless otherwise indicated.
__ Other medication ________________________________________
__ EpiPen Jr. __ EpiPen __ Twinject __ Auvi-Q
Instructions ____________________________________________
___ Give Epipen/Twinject/Auvi-Q at onset of allergic reaction and/or exposure
*If student needs inhaler more than twice a week, please notify parent.
to allergy trigger.
___ Other instructions__________________________________________
Is this student trained and capable of carrying their own inhaler and
using it on their own? ___ YES ___ NO
***IF 2nd DOSE OF TWINJECT OR 2nd EPIPEN/AUVI-Q NEEDED, give:
____ Minutes after 1st Dose
If student not carrying inhaler, it is to be kept:
__ In front office or student classroom
Other medications: _____________________________________________
__ Other _________________________________________________
May student carry own EpiPen/Twinject/Auvi-Q and use on their own?
__ YES __ NO
Please complete both sides of this form. Form MUST be
If student not carrying EpiPen/Twinject/Auvi-Q, it is to be kept:
__ In front office or student classroom __Other ______________

signed by Health Care Provider AND Parent/Guardian.
Initials/Date Reviewed by Health Services School received/sent to Health Services and School Staff ___________ Jefferson County Public Schools Health Services
Primary Care Provider Authorization (PCP): Asthma/Allergy (Side Two)
2013-2014 School Year
Student Name: ______________________________ Date of Birth: _____________ School: _____________________________
EMERGENCY PLAN OF ACTION
1. Follow orders on page 1 for Asthma and/or Allergy treatments and medications.
2. If student is hunched over and/or having dif iculty breathing, walking or talking, blue fingernails or lips, peak flow meter reading in red zone and/or medications not helping, call EMS-
3. Notify school personnel trained in CPR/first aid to respond and initiate CPR if needed prior to EMS arrival.
4. Notify parent/guardian.
5. If EMS is called, the student must be transported via EMS to emergency facility, or parent/guardian must sign release with EMS and then parent/guardian assumes responsibility for
student. The student may not return to school that day. When student is transported via EMS, JCPS staf must ride with student unless parent and/or emergency contact
accompanies them.
6. If student requires medical treatment while on the bus, the bus driver wil contact EMS.
7. Other: ____________________________________________________________________________________________________________________________________________________
FORM MUST BE SIGNED BY HEALTH CARE PROVIDER AND PARENT/GUARDIAN
______________________________ ______________________________ __________________________________ Printed Name of MD, APRN, or PA Address Telephone No. ______________________________ ______________________________ __________________________________ Signature of MD, APRN, or PA Date Fax No. Parent/guardian hereby acknowledges that if this medication is not self-administered, it will most likely be administered by trained, unlicensed JCPS personnel. I
acknowledge and agree when I authorize my child to attend a school sponsored field trip, this medication and/or health service may also be administered by a licensed
volunteer. By signing this form, the parent/guardian shall acknowledge that the Jefferson County Board of Education and its employees shall incur no liability as a result
of any injury sustained by the student from the self-administration of his/her medications to treat asthma or anaphylaxis and the parent/guardian shall indemnify and
hold harmless the school and its employees against any claims relating to self-administration of school medication. This form shall not relieve the liability of the school
or its employees for their own negligence. I hereby give permission for the health care provider completing and signing this form to verify this information with JCPS
and consult with JCPS staff regarding this information.

**Parent/Guardian signature required only for INITIAL 2013-2014 PCP form. Parent/Guardian signature not required for updated 2013-2014 PCP form.
____________________________________ __________________________ PLEASE RETURN THIS COMPLETED FORM TO:
Jefferson County Public Schools - Health Services Department
Lam Building, 4309 Bishop Lane, Louisville, KY 40218 Telephone No. (502) 485-3387 Fax: (502) 485-3670
FINAL 3/7/13

Source: http://www.jcpsky.net/Departments/HealthServicesPromotions/Forms/Asthma-AllergyPCP.pdf

manigs.info

Theory Group, Dept. of Physics and AstronomyUniversity Of Manchester, Manchester, M13 9PL, U.K. 2 Lamarck, Darwin and the rise of neo-Darwinism3 Ecology, Population Biology And Evolution Of Communities4 Theories Of Speciation And Paleontology5 Oxygen Revolution, Thermodynamics And ComplexityEvolutionary theories in biology evoke more controversy both among bi-ologists and among onlookers tha

Material safety data sheet

(form according to EEC Directive 93/112/EC)NAME : LITHIUM, THIONYL CHLORIDE (Li-SOCl2)1 - IDENTIFICATION (of the product and the supplier)LS 14250, LS 14250 C, LS 14500, LS 14500 C, LS 17500, LS 26500, LS 26500 C, LS 33600, LS 33600 C, LSH 26180, LSH 14, LSH 20Solution of lithium tetrachloroaluminate** Lithium tetrachloroaluminate is a combination of lithium chloride (LiCl) and aluminum chlo

Copyright © 2010-2014 Medical Pdf Articles