Y3 2020-21 BJS Healthcare Plan for pupils with medical conditions  
To be completed by the parent or carer of the pupil with medical needs. Once completed you will be required to talk through the form with the a member of our office team and deliver medications in person. We expect you to provide us with in-date medications, that are named and labelled with instructions, and keep us informed of any changes to your child's medical requirements.
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Email *
1. Name of pupil -  name and surname *
2. Child's date of birth *
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3.Year group and class for September 2020 *
4. Contact 1 ( name& relationship) *
5. Contact 1 telephone number *
6. Contact 2 ( name & relationship ) *
7. Contact 2 telephone number *
8. GP Name and contact details *
9. Clinic or hospital. Please give name and contact details of doctor or consultant
8. Medical Condition - does your child have any of these conditions? *
Required
State if your child has an individual healthcare plan devised by a healthcare professional. If you respond yes, please bring a copy of it into school.
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9. Please give further details of the medical condition *
10. Give details of the child's symptons, triggers, signs and treatments, equipment and environment required. *
11. Do we need to make specific arrangements for trips, if so please indicate what these are. *
12. In the event of an emergency, please detail the required procedure ( if different from calling 999 and emergency contacts.) *
13. Medication that is taken daily at home, please specify the name, type, frequency and amount administered .
14. Medication to be taken during school hours ( include name, type, frequency and amount to be administered)
15. Can the pupil self administer their medication ?
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16. Are there any side affects or contradictions to be aware of ?
17. Daily care requirements
18. Specific support for pupil's education, social and emotional needs
19 Date form is completed *
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20. I agree to personally deliver the medication to BJS school office and talk through the requirements with a member of the office team. I will also name the above medication including inhalers and epi pens. *
21. Signature and date to be added to show consent when medication is handed into school.
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