Longmeadow

Primary school

Medical Needs Form

Please complete the below form to inform us of any medical needs your child has.

Child's name* Child's D.O.B* Child's class* List of medical conditions:*

Parent/carer consent: To support school in providing the best medical care for all pupils, we will seek advice from the NHS School Nurse Team. In completing this form and returning it to school, you are consenting to school seeking this support. Please tick to show you have understood this:*I agree

Describe medical needs, including: • details of child’s symptoms • triggers • treatments • facilities • equipment or devices • environmental issues* Treatment details, including: • name of medication • dose • method of administration • when to be taken • side effects • administered by • can it be self-administered with/without supervision*

Emergency Medical Support

What constitutes an emergency?* Action to be taken in emergency: (NB parents/carers will be notified)* Follow-up care advised:*

In the absence of all trained people, the parents must agree to child being present at school on the understanding that 999 will be dialled immediately if an emergency occurs and the parents will then be informed. An individual risk assessment should be completed for pupils with medical needs.

Day to day support

Daily care requirements:* Specific support for the child’s social, emotional and mental health:* Arrangements for school trips, visits etc, including: • equipment / medication • transportation needs • adaptations* Daily care routine (if applicable)*

Medical practitioners