Individual Health Care Plans and Emergency Information Forms
If you have a child with Special Health Care Needs, especially conditions that can potentially result in an emergency situation; it is important to have information readily available to those responsible for your child’s care, whether at school, home or out in the community.
This information can be formatted in 3 ways, depending on your child’s needs: An Emergency Information Form, an Individual Health Plan, or an Emergency Action Plan.
Emergency Information Form
An Emergency Information Form is a form you, as a parent, can use to hand to doctors when you go to the emergency room with your child. For children with complex needs or conditions which potentially require emergency assistance, have a completed, updated form taped to your front door or on a jump drive ready to go to the hospital when EMS are called. There should also be a copy at school to be sent with your child, should your child require transport to an ER during school hours. Medical emergencies can be complicated for children with special health care needs. Having an Emergency Information Form makes it easier for doctors to treat your child during an emergency. The form includes:
- a place to record contact information for your child
- a list of your child's physicians and their contact information
- base-line findings
- procedures to be avoided
- common presenting problems with specific suggested managements for your child
- For children with complex needs, specific information such as trach type and size, vent settings, feeding tube type and size, central line type, and other specific equipment needs are important to include
- Sample Emergency Information Form (word doc)
Individual Health Plans
An Individual Health Plan (IHP) can be developed for your child’s home or school. The IHP:
- Gives the school or caregivers necessary medical information about your child
- Identifies your child’s health needs and how to manage them, such as giving medication or other medical treatments needed at school or home
- Creates solutions to potential health problems that can occur in a school environment
- Develops plans for emergency medical situations — this can stand alone as an Emergency Action Plan (EAP) or Emergency Care Plan (ECP)—see below.
- Provides a safe environment that helps your child learn and optimize their ability to function.
- Makes goals for your child’s health care, such as having your child work towards remembering to take medication
To create an IHP for your child, work with your child’s physician. Most physicians have IHP forms for specific health conditions, and most forms require the physician’s signature prior to submitting it to your child’s school. Below are both general, blank sample health plans, as well as plans that are specific to a child’s condition. Often, IHPs are combined with Emergency Action Plans in one document and are kept together at the school.
- General Sample Individual Health Plan
The general sample IHP is a great tool to develop a specific health plan for your child in conjunction with your child’s physicians and school.
- Asthma Individual Health Care Plan and combined action plan — MN Department of Health
- Diabetes Individual Health Care Plan
Emergency Care Plans
An Emergency Care Plan (ECP) is a plan that gives specific steps for school professionals to take when your child has a medical emergency. An ECP is written for a child who is more likely to have a specific medical emergency, such as a seizure if they have epilepsy or hypoglycemia if they are diabetic. The ECP can be part of the IHP, IEP, 504 plan or stand-alone document. The form includes:
- Immediate steps to take to address the emergency
- Person to contact that is trained to handle specific emergency
- Location of medications
- When medication administration is needed
- When to call 911
- When to transport to ER
- When to contact parent
- Asthma Emergency Care Plan
- Diabetes Emergency Care Plan
- Food Allergy Emergency Care Plan
- Allery and Anaphylaxis Emergency Care Plan — American Academy of Pediatrics
- Latex Allergy Emergency Care Plan
- Insect Sting Emergency Care Plan
- Seizure Disorder Emergency Care and Individual Health Care Plan
- Seizure Action Plans — Epilepsy Foundation