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Exhibit JHCE5ANAPHYLAXIS STANDARD HEALTH CARE PLAN (SHIP) Child name:Gender:Birth date:School/child care facility:Grade (if applicable):Parent/guardian name:MHSC:Primary Phone #:Secondary Phone #:PAIN:Parent/guardian
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How to fill out school based health consent

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How to fill out school based health consent

01
Step 1: Obtain the school based health consent form from the school or healthcare provider.
02
Step 2: Fill out the patient's information including name, date of birth, and contact information.
03
Step 3: Provide information about the healthcare provider or facility that will be providing services.
04
Step 4: Specify the type of health services that the student is authorized to receive.
05
Step 5: Sign and date the form, if required, by both the parent/guardian and the healthcare provider.
06
Step 6: Return the completed form to the appropriate school or healthcare provider.

Who needs school based health consent?

01
Any student who requires medical attention or services while at school may need school based health consent.
02
Parents, guardians, or legal representatives of students may also need to provide consent for their child to receive health services at school.
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School based health consent is a form that grants permission for health services to be provided to students at school.
Parents or legal guardians of the students are required to file school based health consent.
School based health consent can be filled out by providing personal information of the student, medical history, insurance information, and signing to give permission for health services.
The purpose of school based health consent is to ensure that students can receive necessary health services while at school with the permission of their parents or legal guardians.
Information such as student's name, date of birth, medical history, insurance information, emergency contacts, and permission for specific health services must be reported on school based health consent.
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