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Each Specialized Physical Healthcare Procedure NOW has a specific authorization form posted next to the protocol guideline below. The authorization form has both the parent and licensed healthcare provider in one page with the parent section available in four languages.
 
Related Forms: 
B.   Specialized Physical Health Care Services, Guidelines (Rev. 4/2017)
C.   2017/2018 - Specialized Physical Health Care Services, Form (5/2017) 
D.   Review for Support Services Due to Health Needs -Complete for Student with Protocol Before the IEP
       Meeting 
E.   Protocol and Medication Checklist Form- Medication/Protocol Checklist for Licensed and Unlicensed
        Assistive Personnel 
 
 
Anaphylaxis
Authorization Forms with the Parent Section in Different Languages (5/2017):
   
Catheterization
a. Clean Catheterization (Rev. 6/15)
   Authorization Forms with the Parent Section in Different Languages (5/2017)
 
    Authorization Forms with the Parent Section in Different Languages (5/2017)
 
   Authorization Forms with the Parent Section in Different Languages (5/2017)
 
d. Sterile Catheterization  (Rev. 05/2016)
   Authorization Forms with the Parent Section in Different Languages (5/2017)
 
 
Diabetic Protocols
 
Authorization Forms for Generic Diabetic Protocols 
 
   For LAUSD Food Services Web Page for Menu click here; for carbohydrate count click here
        Refer to LAUSD Menu for specific food item name
   Note: The interactive menu is no longer in use.
 
 
Gastrostomy
    Authorization Forms with the Parent Section in Different Languages (5/2017) 
 
    Authorization Forms with the Parent Section in Different Languages (5/2017) 
 
    Authorization Forms with the Parent Section in Different Languages (5/2017) 
  
Jejunostomy
 Authorization Forms with the Parent Section in Different Languages (5/2017) 
 
 
 Authorization Forms with the Parent Section in Different Languages (5/2017) 
 
 
Mechanical Ventilation (Rev. 5/2016)
 Authorization Forms with the Parent Section in Different Languages (5/2017) 
Other Related Forms/Information 
 
Ostomy Care (Rev. 4/2017)
 Authorization Forms with the Parent Section in Different Languages (5/2017) 
 
 
Oxygen Therapy (Rev. 12/15)
   Authorization Forms with the Parent Section in Different Languages (5/2017) - uploading in progress
 
 
Seizure Care
Protocols:
1.   Diazepam Rectal Gel (Diastat) Administration  (11/15) - MUST be completed with the above protocolSeizure Action Plan and       Parent Questionnaire (see below) 
      Authorization Forms with the Parent Section in Different Languages (5/2017)
      Authorization Forms with the Parent Section in Different Languages (5/2017)
  
      Related Forms and Information
      c. Seizure Action Plan 
      d. Seizure Record
      e. Parent Questionnaire for Students with Seizures
          (1) English/Spanish (2)  English/Armenian (3) English/Chinese (4) English/Korean
   
Suctioning
Protocols 
   1. Oral Nasal Suctioning (Rev. 6/15)
       Authorization Forms with the Parent Section in Different Languages (5/2017)
 
      Authorization Forms with the Parent Section in Different Languages (5/2017)
 
   3. Tracheostomy Suctioning (Rev. 6/15)
      Authorization Forms with the Parent Section in Different Languages (5/2017)
   4. Tracheostomy Tube Replacement (Rev. 6/15)
      Authorization Forms with the Parent Section in Different Languages (5/2017)
Related Forms:
 
 
   
   
 
 
 
 
 
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