Medical Forms

For Students with Medical Conditions or Requiring Medication


According to the Birmingham Public Schools medication policy, all medications administered by the BCS office must have proper paperwork on file. Proper paperwork includes:

  • BPS Permission to Administer Medication Form
    • This form must be completed and signed by the parent/guardian for over-the-counter medications or by the parent/guardian and the child’s doctor for prescription medications. The information on the form(s) must exactly match the medication(s) submitted to the BCS office. There will be no exceptions.


  • BPS Care and Action Plans
    • A specific Care or Action Plan is required if the student has ASTHMA, A SEVERE ALLERGY, AN INSECT STING REACTION, DIABETES, OR A SEIZURE DISORDER. The Care or Action Plan must be completed and signed by the parent/guardian and the child’s doctor. A Care or Action Plan may need to be completed and filed with BCS even if the student does not require regular medications while in school.

  1. Guidelines for Student Medications at BCS
  2. Permission to Administer Medication Form
  3. Care Plans for Medical Conditions
    1. Asthma Letter and Asthma Action Plan
    2. Food Allergy Letter and Food Allergy Care Plan
    3. Diabetes Letter and Diabetes Medical Forms
    4. Bites and Stings Fact Sheet
    5. Seizure Letter and Seizure Action Plan

Please contact Nancy Best at 248-203-4522 or with any questions.

Forms are in PDF format and Acrobat Reader is required to view them.
For further details on installing and using Acrobat Reader click here

If you already have Acrobat Reader on your computer the files above may automatically open when you click on them. If they do not, you need to right click,  select "save target as" from the menu which appears, save the file to your hard disk and then start acrobat reader and open the file from the file menu.