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  • Protocols

    Each Specialized Physical Healthcare Service (SPHCS) or protocol has specific authorization form posted under the protocol guidelines.

A. Specialized Health Care Services:
   (1)  Form
   (2)  Guidelines
D. For a protocol or SPHCS that is not listed on the standardized specialized physical health care services, please download the Generic Authorization Form (English/Spanish)
        Assistive Personnel
I. Review for Support Services Due to Health Needs -Complete for Student with Protocol Before the        IEP Meeting



Solu-Cortef Protocol Guidelines


Authorization Forms:

English/Spanish - Other languages are not available

Emergency Medication Authorization


Related Forms and Information:

Emergency Care Plan for School

Adrenal Insufficiency - Power Point



Protocols Guidelines: 
Attachments: Attachment A - Printer Friendly Version Authorization Form
                       Attachment B - Anaphylaxis Guidelines
                       Attachment C - Letter Template
                       Attachment D - Special Diet Form. For the most recent version of the Special Diet form, click here
Authorization Forms: (5/2017)
a. Clean Catheterization Guidelines (3/2019)
   Authorization Forms for Clean Catheterization (5/2017)
    Authorization Forms for Clean Self-Catheterization with Assistance (5/2017)
c. Clean Self-Catheterization Guidelines (3/2019)
   Authorization Forms for Clean Self-Catherization (5/2017)
d. Sterile Catheterization Guidelines (3/2019)
   Authorization Forms for Sterile Catheterization (5/2017)
e. Training Videos Link
1. Blood Glucose Testing (3/2019)
2. Baqsimi (Glucagon Nasal Spray) (12/2021)
3. Glucagon Injection (Severe Hypoglycemia) (3/2019)
4. Hypoglycemic Reaction (3/2019)
Authorization Forms:
3. Glucagon Injection (1/2020)
Other Related Forms and Information:

For LAUSD Food Services Web Page for Menu click here; for carbohydrate count click here.



 Epinephrine for Schools Resource Page

    Authorization Forms for Gastrostomy Feeding: Bolus Method (5/2017) 
    Authorization Forms for Gastrostomy Feeding: Slow Drip Method or Pump (5/2017) 
    Authorization Forms for Gastrostomy Tube Replacement (5/2017) 
d. Training Videos Link
 Authorization Forms for Jejunostomy Tube Feeding: Slow Drip Method or Pump (5/2017) 
Protocol Related Form:  Special Diet Form
Mechanical Nebulizer Treatment - Guidelines (3/2019)
Authorization Forms with the Parent Section in Different Languages (5/2017) 
Mechanical Ventilation Guidelines (3/2019)
 Authorization Forms for Mechanical Ventilation (5/2017) 
Other Related Forms/Information 


Ostomy Care (3/2019)

Authorization Forms with the Parent Section in Different Languages (5/2017) 
Oxygen Therapy - Guidelines (3/2019)
Authorization Forms for Oxygen Therapy (5/2017)

1. Benzodiazepine (Valtoco and Nayzilam) Guidelines (8/2021)
    Authorization Forms for Valtoco or Nayzilam
2. Diastat - Diastat Guidelines  (3/2019)
     Authorization Forms for Diastat (5/2017)
 3. Vagus Nerve Stimulation (VNS) - VNS Guidelines (3/2019)
    Authorization Forms for VNS (5/2017)
Related Forms and Information
      b. Seizure Action PlanEnglish/Spanish
      c. Seizure Record
      d. Parent Questionnaire for Students with Seizures
          (1) English/Spanish (2) English/Armenian (3) English/Chinese (4) English/Korean
   1. Oral Nasal Suctioning (3/2019)
       Authorization Forms for Oral/Nasal Suctioning (5/2017)
      Authorization Forms for Oropharyngeal and Nasopharyngeal Suctioning (5/2017)
   3. Tracheostomy Suctioning(3/2019)
      Authorization Forms for Tracheostomy Suctioning (5/2017)
      Authorization Forms for Tracheostomy Tube Replacement (5/2017)
Training Videos Link and Related Forms:
  • Announcements

    Immunization Program and SMS School-based Clinics Schedule

     CPR Class Schedule    LAUSD American Heart Association