Dear Parent,
Our records indicate that your child has a history of seizures that may require treatment at school.
Please bring all supplies and the Seizure Medical Management Plan to the school clinic by the first day of
school.
Your child’s forms and supplies should include:
 Seizure Management and Treatment Plan
 Diastat or other medication if prescribed
 Medication request form
 Oxygen and supplies if prescribed
 Vagus Nerve Stimulator if prescribed
In order for your child to have the best possible school year, it is important that I have the necessary
supplies and proper authorizations to provide appropriate care and respond in the case of an
emergency.
All forms necessary, for proper care while your child is at school, can be found on our website
at: http://www.pisd.edu/parents/health/index.shtml
Please call me to determine a time we can meet to discuss the plan that has been developed by you and
your health care provider.
Sincerely,
School Nurse
Phone
Revised May 2013