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Medical conditions form
Please only complete this form IF your child has a medical condition. Thank you
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* Indicates required question
Name of child
*
Your answer
School attended
*
Luddington & Garthorpe
Eastoft
Medical diagnosis or condition
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Your answer
Clinic contact (name, name of hospital/GP and phone number)
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Your answer
Describe medical needs and give details of child's symptoms, triggers, signs, treatments, facilities, equipment or devices, environmental issues etc
*
Your answer
Name of medication, dose, method of administration, when to be taken, side effects, contra-indications, administered by/self-administered with/without supervision
*
Your answer
Daily care requirements
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Your answer
Specific support for the pupil's educational, social and emotional needs
*
Your answer
Arrangements for school visits/trips etc
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Your answer
Other information
Your answer
Describe what constitutes an emergency and the action to take if this occurs
*
Your answer
Any other comments/questions
Your answer
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