Medical Details Form Student’s Name: ______________________________________ Year Level: _______ Roll Class: _______
My child does not have any known medical conditions
My child has the following known medical conditions.
Medical Condition 1: Medical Condition Category:
(Please use list of Medical Condition Categories provided) Symptoms:
(Include specific medical condition name if known and any symptoms school should look for) Management: (Include any special
instructions the school should follow with regard to this condition) Medical Condition 2: Medical Condition Category:
(Please use list of Medical Condition Categories provided) Symptoms:
(Include specific medical condition name if known and any symptoms school should look for) Management: (Include any special
instructions the school should follow with regard to this condition) Medical Condition 3: Medical Condition Category:
(Please use list of Medical Condition Categories provided) Symptoms:
(Include specific medical condition name if known and any symptoms school should look for) Management: (Include any special
instructions the school should follow with regard to this condition) If your child has additional medical conditions please attach details of all medical conditions. __________________________
Education Queensland Standardised Medical Condition Category List Acquired brain injury Allergies/Sensitivities Anaphylaxis Airway/lung/breathing – Oxygen required (continuously/periodically) Airway/lung/breathing – Suctioning Airway/lung/breathing - Trachestomy Airway/lung/breathing – Other Artificial feeding – Gastrostomy device (tube or button) Artificial feeding – Nasogastric tube Artificial feeding – Jejunostomy tube Artificial feeding – Other Asthma Attention-deficit/Hyperactivity disorder (ADHD) Bladder and bowel – Urinary wetting, incontinence Bladder and bowel – Faecal soiling, constipation, incontinence Bladder and bowel – Catheterisation (continuous, clean intermittent) Bladder and bowel – Stoma site, urostomy, Mitrofanoff, MACE, Chair Bladder and bowel – Other Blood disorders – Haemophilia Blood disorders – Thalassaemia Blood disorders – Other Cancer/oncology Coeliac disease Cystic Fibrosis Diabetes – type one Diabetes – type two Ear/hearing disorders – Otitis Media (middle ear infections) Ear/hearing disorders – Hearing loss Ear/hearing disorders – Other Epilepsy – Seizure Eye/Vision disorders Endocrine disorder – Adrenal hypoplasia, pituitary, thyroid Heart/cardiac conditions – Heart valve disorders Heart/cardiac conditions – Heart genetic malformations Heart/cardiac conditions – Other Mental Health – Depression Mental Health – Anxiety Mental Health – Oppositional defiant disorder Mental Health – Other Muscle/bone/musculoskeletal disorders – spasticity (Baclofen Pump) Muscle/bone/musculoskeletal disorders – Other Skin disorders – eczema Skin disorders – psoriasis Swallowing/dysphagia – requiring modified foods Swallowing/dysphagia – requiring artificial feeding Transfer & positioning difficulties Travel/motion sickness Other
CURRICULM VITAE Susie H. Park, Pharm.D., BCPP, FCSHP PERSONAL INFORMATION Title: Assistant Professor of Clinical Pharmacy and Pharmaceutical Economics and Policy University of Southern California School of Pharmacy 1985 Zonal Avenue Los Angeles, CA 90033-0804 EDUCATION 1989-1993 University of California, San Diego La Jolla, California Bachelor of Arts Psychology (Cum La
TREATMENT AND PROPHYLAXIS OF SCABIES A. Application of Scabicides: General Principles 1. Gowns and gloves are worn when applying scabicides to patients. 2. Bathe patients as usual and change bed linens. Allow skin to cool 3. Apply scabicide to every square inch of skin, from the posterior ear folds down over the entire body. Include intergluteal cleft, umbilicus, skin folds, palms a