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St. James' CE Primary School

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My child needs medicine at school
My child's school asthma card
Annual flu vaccination

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Medical Needs in School
My child's school asthma card

My child's school asthma card

This card is for your child’s school. Review the card at least once a year and remember to update or exchange it for a new one if your child’s treatment changes during the year. Medicines and spacers should be clearly labelled with your child’s name and kept in agreement with the school’s policy.

Full Name of Child* Date of Birth* Please enter full address* Primary Guardian/Carer's Name* Primary Guardian/Carer's Mobile Telephone No.* Primary Guardian/Carer's Home Telephone No.* Primary Guardian/Carer's Email Address* Doctor/Nurse's Name* Doctor/Nurse's Telephone No.* Reliever treatment when needed for shortness of breath, sudden tightness in the chest, wheeze or cough, help or allow my child to take the medicines below. After treatment and as soon as they feel better they can return to normal activity. State below medicine to be administered and type your signature to show your consent. If the school holds a central reliever inhaler and spacer for use in emergencies, I give permission for my child to use this. Type your signature and the date to show your consent. List Medicine/Expiry Date/Date Checked What signs can indicate that your child is having an asthma attack?*

Does your child tell you when he/she needs medicine?*YesNo

Does your child need help taking his/her asthma medicines?*YesNo

What are your child’s triggers (things that make their asthma worse)?PollenStressExerciseWeatherAir Pollution

If there are other factors, please state what they are below:

Does your child need to take any other asthma medicines while in the school’s care?*Yes (if yes, please describe them below)No

If answered Yes above, please list which medicine, how much and when to take. Please sign and date your name below as verification that this information is believed to be correct at time of submission.*