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Health Forms

Randolph Health Forms

Health Conditions/

Medication at School

***If your child is new to Randolph and has a health condition, or if your current Randolph student has developed a new health condition that we are not aware of yet, please contact Mrs. Bice at jbice2@livoniapublicschools.org or Mrs. Wehner at awehner@livoniapublicschools.org as soon as possible before the first day of school.  

Dear Families,

Please download the forms your child needs for school, based on their health conditions.  New forms must be completed by you and your child’s physician each year (dated after the last day of school of the previous school year).  Please ensure that the forms include both your signature and your child’s doctor’s signature.  We cannot dispense any medication without these completed forms.  

***Note:  A “Medication Authorization,” which is included in the packets for each health condition, needs to be completed for each medication.  Here’s a quick link, if your child has more than one medication.

Life-Threatening Food and/or Insect Allergy (Forms for this Section Available Here)

  • Allergy IHCP
  • Medication Authorization (one for each medication)
  • Nut & Seed Restricted Lunch Table Guidelines
  • Lunch Table Needs Lunchroom Addendum
  • Parent Medication Drop-Off Checklist
  • Letter from Principal—Randolph Student Medications at School

Asthma (Forms for this Section Available Here)

  • Medication Authorization (one for each medication)
  • Parent Medication Drop-Off Checklist
  • Letter from Principal—Randolph Student Medications at School

Diabetes (Forms for this Section Available Here)

  • Diabetes IHCP
  • Medication Authorization (one for each medication)
  • Parent Medication Drop-Off Checklist
  • Letter from Principal—Randolph Student Medications at School

Seizure Disorder (Forms for this Section Available Here)

  • Seizure IHCP
  • Medication Authorization (one for each medication)
  • Parent Medication Drop-Off Checklist
  • Letter from Principal—Randolph Student Medications at School

Other (Forms for this Section Available Here)

  • Medication Authorization (one for each medication)
  • Parent Medication Drop-Off Checklist

Please make sure that the forms are very specific.  For example, if your doctor says the medication can be distributed “as needed,” ask them to define a limit, such as “as needed up to three times in a school day.”

It is our hope that all of the forms will be returned to Randolph (or Johnson for current 4th graders) on the first day of school.  It is very important that we have all of this information on file in the office and distributed to the staff and teachers to keep your child safe.  Please drop off your child’s completed Health Care Plan, Medication Authorization, and medication on the first day of school.  

If you have any questions or would like to set up a meeting to discuss your child’s health care plan, please contact Mrs. Bice at jbice2@livoniapublicschools.org or Mrs. Wehner at awehner@livoniapublicschools.org (email is the best way to reach us).  When school is open, you may also call the Randolph Office at (734) 744-2770 and ask for one of us.

Thank you so much for your support and have a wonderful summer!

Sincerely,

Mrs. Bice & Mrs. Wehner

Randolph Elementary Support Teachers (ESTs)