Please complete this form by 30/09/2021
Form from: Windsor Girls' School

INDIVIDUAL HEALTH CARE PLAN

The following information needs to be completed as accurately as possible. Any additional information such as supporting leaflets may be attached. Please inform the school if there are any updates or changes to your daughter’s condition.


Name

Condition

Daily care/needs

Longterm care/needs

Medication

Name of Medicine(s)

Dosage

Times required

Self-Administered/School Administered

Emergency Contact

Name

Phone Number

Relationship to student

Additional Information

Please provide any other information which would be useful for school to know

School Use Only

Information received by

Date

Planned Date of Review