Life Threatening Food Allergies
To ensure the safety of your son or daughter who has a life-threatening food allergy medical orders, medication/equipment, a nursing care plan must be in place prior to attending school.

Please review the resources available below. Contact your school office, school nurse or child nutrition services if you have any questions.

All forms may be obtained from your school nurse or by clicking on the links below. Remember, many of these forms need a physician’s signature and must be on file with the school nurse to provide a safe environment for students with severe food allergies.

1. Medical Statement For Student Requiring Special Meals (Form P2840c)
2. Food Allergy Reference Form (Form P2840)
3. Food Allergy Action Plan (Form P2840b)
4. Waiver For Self Administration of Medication (Form P2870a)
5. Request for Medication to be given at school (Form P2870b)

Forms must be returned to school and reviewed/approved by the school nurse before a student can attend school. Please include any additional information that you or the licensed health provider would like to share.

Mild Food Allergies
While these food allergies are not life threatening, they can still be bothersome and symptoms can distract a child from their learning. Please complete the following forms and return to your school nurse.

1. Food Allergy Reference Form (Form P2840)
2. Medical Statement For Student Requiring Special Meals (Form P2840c)
3. Request for Medication to be given at school (Form P2870b)

Again, any questions may be directed to your school nurse or child nutrition services.

Other Dietary Issues
Some students may have other special dietary needs due to diabetes, celiac disease, etc. If your child has special dietary needs, please complete the following forms

1. Medical Statement For Student Requiring Special Meals (Form P2840c)
2. Request for Medication to be given at school (Form P2870b) (if necessary)
   Medical documentation of any needed procedures or plans of care for the school setting
3. If you have any questions or concerns, please contact the principal or school nurse at the school your child attends.

Additional contact persons available to you:

• Amy Wehr, wehramy@rockwood.k12.mo.us 
  Supervisor, Wellness and Health Services(636) 733-2008
  
• Carmen Fischer, fishcercarmen@rockwood.k12.mo.us 
  Director, Child Nutrition Services (636) 733-3251

Please report immediately any changes needed in emergency contact information, medication, health status, etc. Thank you for your continued assistance in helping us provide a safe school experience for your child.