Midtown West (PS 212)
  • OUR SCHOOL
    • School Handbook
    • CURRICULUM
    • GENERAL PROCEDURES
    • CLASSROOM & STAFF
  • Admissions
  • EVENTS
  • PTA
    • MTW PTA COMMITEES
    • FUNDRAISING COMMITTEE >
      • Fundraising
      • Student Fund / Corporate Match
      • Volunteer Sign Up
    • LIBRARY COMMITTEE
  • Extended Day
    • Registration
    • Fees & Charges
  • Contact

Medical Forms

Chronic Health Issues
If your child has a severe, chronic health issue,
including but not limited to asthma or anaphylaxis, you must compete and return the appropriate forms below before your child can begin the program. Parents are required to provide pertinent medical information and the appropriate emergency medication, i.e., asthma pump or EpiPen, for chronic health issues such as asthma or anaphylactic shock due
to severe food allergies. Parents must replace any expired medication and update all forms and information whenever necessary.

The ED Health Action Plan is required by everyone in addition to the Asthma and/or Anaphylaxis forms as needed. These forms can also  be forwarded to the school nurse.

Extended Day Medical Form - Health Action Plan  (required)

ext_day_health_action_plan-asthma-allergy-chronic_condition.pdf
File Size: 186 kb
File Type: pdf
Download File


​
​Asthma Form (If appropriate)

asthma-medication-administration-form-2022-23.pdf
File Size: 324 kb
File Type: pdf
Download File

​
​Allergies/Anaphylaxis Form
(if appropriate)

allergies-anaphylaxis-medication-administration-form-2022-23.pdf
File Size: 325 kb
File Type: pdf
Download File

  • OUR SCHOOL
    • School Handbook
    • CURRICULUM
    • GENERAL PROCEDURES
    • CLASSROOM & STAFF
  • Admissions
  • EVENTS
  • PTA
    • MTW PTA COMMITEES
    • FUNDRAISING COMMITTEE >
      • Fundraising
      • Student Fund / Corporate Match
      • Volunteer Sign Up
    • LIBRARY COMMITTEE
  • Extended Day
    • Registration
    • Fees & Charges
  • Contact