JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
TWS - Health Care Plan Review
To support our review of Health Care Plans, please complete the following in as much detail as possible.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Pupil's name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Year group
*
Your answer
Family contact in emergency - 1 (Name, relationship and contact details)
*
Your answer
Family contact in emergency - 2 (Name, relationship and contact details)
*
Your answer
Hospital/Doctor contact details
*
Your answer
Medical diagnosis or condition
*
Your answer
Describe medical needs and give details of child’s symptoms, triggers, signs, treatments, facilities, equipment or devices, environmental issues
*
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
*
Your answer
Specific support for the pupil’s educational, social and emotional needs
*
Your answer
Arrangements for school visits/trips
*
Your answer
Other information
Your answer
Describe what constitutes an emergency, and the action to take if this occurs
*
Your answer
Do you give consent for The Whitstable School to administer medicine?
*
Yes
No
Any other relevant information
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Swale Academies Trust.
Report Abuse
Forms
