• 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
 
 
C. 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
H. Review for Support Services Due to Health Needs -Complete for Student with Protocol Before the        IEP Meeting
 
  
  

 

Guidelines

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: 
 
 
Authorization Forms: (5/2017):
 
 
 
 
 
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)
 
 
Guidelines:
 
1. Blood Glucose Testing (3/2019)
2. Hypoglycemic Reaction (3/2019)
3. Glucagon Injection (Severe Hypoglycemia) (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

Gastrostomy
 
    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) 
 
  
Jejunostomy
 
 Authorization Forms for Jejunostomy Tube Feeding: Slow Drip Method or Pump (5/2017) 
 
 
 
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)
 
 
 
Protocols:
1.  Diastat - Diastat Guidelines  (3/2019)
Authorization Forms for Diastat (5/2017)
 
2.   Vagus Nerve Stimulation (VNS) - VNS Guidelines (3/2019)
Authorization Forms for VNS (5/2017)
Related Forms and Information
      c. Seizure Action PlanEnglish/Spanish
      d. Seizure Record
      e. Parent Questionnaire for Students with Seizures
          (1) English/Spanish (2)  English/Armenian (3) English/Chinese (4) English/Korean
Protocols 
   1. Oral Nasal Suctioning (3/2019)
       Authorization Forms for Oral/Nasal Suctioning (5/2017)
 
      Authorization Forms for Oropharyngeal and Nasopharyngeal Suctioning (5/2017)
 
      Authorization Forms for Tracheostomy Suctioning (5/2017)
      Authorization Forms for Tracheostomy Tube Replacement (5/2017)
 
Related Forms:
 
 
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