Individual Health Care Plan Referral

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IHCP's are required to ensure your child's Health needs are met within the Academy.

If you feel your child has a medical condition which the academy needs to be aware of, or they are required to take medication in school, please complete the below form.

This should also include medical conditions such as Asthma and Epilepsy.

If your responses require an IHCP to be completed, a member of staff will be in touch to arrange a meeting.

Student Name *

Year Group *

Year 7

Year 8

Year 9

Year 10

Year 11

Year 6 - Transition

Parent Name and Contact Information *

Does your child have a diagnosed medical condition? *

Yes

Medical Diagnosis *

Is your child required to take medication for their condition? *

Yes

If so, is the medication prescribed by the GP? *

Yes

Has your child previously had an IHCP in school? *

Yes

Maybe

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