Health Center Forms

Frequently used forms such as asthma action plan, seizure action plan, adrenal action plan, allergy/anaphylaxis action plan, and medication orders that need to be completed by the student’s healthcare provider.

If a student has one of the following conditions: seizures, diabetes, adrenal insufficiency, asthma, an allergic reaction requiring Benadryl or Epi-Pen, the student will be required to have an “Emergency Action Plan” completed by the student’s health care provider (allergist, neurologist, endocrinologist, pulmonologist, etc.).

Students must bring their prescribed emergency medications that are listed on the Emergency Action Plan with them at registration and each time they return to TSBVI. Some examples of emergency medications include Diastat, MIdazolam, Xopenex, Solu-Cortef, Epi-pens, and Glucagon.

Epi-Pens and Emergency Treatment for Anaphylaxis

Read the TSBVI statement on Epi-Pens and Emergency Treatment for Anaphylaxis (DOC).