INDIVIDUAL HEALTH CARE PLAN

Please fill in this form if your child has a medical condition or requires regular medication with us.
(e.g. nappy rash cream, an inhaler, bug spray etc.)

Arohanui,
Your Old Mac’s whaanau.

Child's Name

First Name

Last Name

Please state your child's enrolled classroom

Please list the health condition diagnosis

Please describe in detail the symptoms that your child may experience:

Actions to be taken:

Please be very specific here in terms of dosage and how often. e.g. A pea sized amount of Bepanthen at every nappy change where the skin is red and irritated

Are there any limitations to your child's day to to this health condition?

Does your child have any additional daily care needs?

Please list your child's medical centre and GP:

Please list your best emergency contact and their number: