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HomeMy WebLinkAboutMedical Alert Care Plan.pdfMEDICAL ALERT CARE PLAN CHILD’S NAME: _____________________________ DATE: _______________ Describe the potential medical problem: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Precautions to take at the facility: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Symptoms to watch for: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Step By Step Plan Staff Need to follow When Child Shows Symptoms: 1._________________________________________________________________ 2._________________________________________________________________ 3._________________________________________________________________ 4._________________________________________________________________ 5._________________________________________________________________ At what point should an ambulance be called to take your child to the hospital: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Are there any medications that may need to be administered while your child is in our program: ___________________________________________________________________ ___________________________________________________________________ Parent/Guardian Signature______________________________