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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 of 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: 
                       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 Form:English/Spanish (2/2023)
a. Clean Catheterization Guidelines (3/2019)
   Authorization Form for Clean Catheterization (2/2023): English/Spanish
    Authorization Form for Clean Self-Catheterization with Assistance (2/2023) English/Spanish
 c. Clean Self-Catheterization Guidelines (3/2019)
   Authorization Form for Clean Self-Catherization (2/2023) English/Spanish
d. Sterile Catheterization Guidelines (3/2019)
   Authorization Form for Sterile Catheterization (2/2023) English/Spanish
e. Training Videos Link
2. Baqsimi(Glucagon Nasal Spray/Severe Hypoglycemia) (12/2021)
3. Glucagon Injection(Severe Hypoglycemia) (3/2019)
Authorization Forms:
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 Form (2/2023): English/Spanish
    Authorization Form (2/2023): English/Spanish
    Authorization Form (2/2023): English/Spanish
d. Training Videos Link
 Authorization Form (3/2023): English/Spanish
Protocol Related Form:  Special Diet Form
Mechanical Nebulizer Guidelines (3/2019)
Authorization Form with the Parent Section (2/2023): English/Spanish
Mechanical Ventilation Guidelines (3/2019)
 Authorization Form for Mechanical Ventilation (2/2023): English/Spanish
Other Related Forms/Information 


Ostomy Care (3/2019)

Authorization Form (2/2023): English/Spanish

Oxygen Therapy  - Guidelines (3/2019)

Authorization Form (3/2023): English/Spanish

    Authorization Form: English/Spanish
2. Diastat - Diastat Guidelines  (3/2019)
     Authorization Form (3/2023): English/Spanish
3. Vagus Nerve Stimulation (VNS) - VNS Guidelines (3/2019)
    Authorization Form (3/2023): English/Spanish
Related Forms and Information
      b. Seizure Action PlanEnglish/Spanish
      c. Seizure Record
      d. Parent Questionnaire for Students with Seizures: English/Spanish
   1. Oral Nasal Suctioning (3/2019)
       Authorization Form for Oral/Nasal Suctioning (3/2023): English/Spanish
      Authorization Form: (3/2023): English/Spanish
   3. Tracheostomy Suctioning(3/2019)
      Authorization Form: (3/2023): English/Spanish
      Authorization Form (3/2023): English/Spanish
Training Videos Link and Related Forms:
  • Announcements

    Immunization Program and SMS School-based Clinics Schedule

     CPR Class Schedule    LAUSD American Heart Association