Medical Alert Form School District No. 43, Coquitlam School Board

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SCHOOL DISTRICT #43 (COQUITLAM)
MEDICAL ALERT FORMS 
FORM(S) MUST BE COMPLETED AT THE START OF EACH SCHOOL YEAR 
 
Please read instructions below carefully. Feel free to contact your school if you need any clarifications.   
This document contains EIGHT pages as we have combined all FOUR medical forms into one to make it easier for 
parents to find them and fill them out. This will ensure schools have the all necessary forms completed to maintain a 
safe and efficient procedure for all students.   
Complete only the appropriate form(s) and submit them as soon as possible to comply with School Board Procedures.   
Instructions
1. Read the description for each form and choose which applies to your child.   
2. Indicate which form(s) you need to complete by selecting the checkbox next to that form.   
3. Click on the form button in the table below and fill out the actual form. Use the 
button   
at the bottom of each page to quickly get back to this table and the submit button.   
4. Repeat step 3 for the next form(s) if it applies.   
5. After completing all forms that apply to your child, click on the submit button at the bottom of this page. 
 
Checkbox 
Form Name 
Description 
Pages 
Select all that applies 
Click on form button to access form 
 
Complete this basic required form if your child 
   
has a medical condition that needs 
 
2 to 3 
precautionary treatment or medication at 
school. 
 
New form is available at this link.
 
 
   
 
 
Complete this form ONLY if your child needs an 
4 to 5
 
anaphylaxis emergency action plan*. 
 
 
 
 
New forms are available at this link.
 new
 
* Both the Anaphylaxis Emergency Action Plan and the Diabetic Action Plan has been collaboratively developed by Public Health, and School District No. 43.
The information collected on this form is subject to and protected by the provisions of the Freedom of Information and Protection of Privacy Act.
 
 

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