School Nurse Chronic Condition Tracking Form

The purpose of this tracking form is to assist school nurses in obtaining and tracking the needed paperwork and/or writing the needed plans for students with a
condition that requires treatment, medication, case management, or health care coordination in the school. Due to personal identifiers, this form should be
stored in a secure location compliant with student privacy policies, regulations, and/or laws.

Definitions:
 Emergency Action Plan (EAP): This plan is typically completed by the healthcare provider and includes parameters for emergency care in the event of a prolonged
seizure as well as prescribed rescue medications and instructions for use. The school nurse often uses this to develop an individualized and/or emergency care plan
(NASN, 2018).
 Emergency Care Plan (ECP): This plan is developed by the registered professional school nurse using clear terminology that can be easily understood by school
personnel and non-medical professionals. An ECP uses the medical information found in the EAP and expands it to include nursing considerations and school-site-
specific processes, such as where medication is stored, who will do what, and what procedures school personnel should follow (NASN, 2018).
 Individualized Healthcare Plan (IHP): Plan “developed by the school nurse using the nursing process in collaboration with the student, family and healthcare
providers. The school nurse utilizes the IHP to provide care coordination, to facilitate the management of the student’s health condition in the school setting, to inform
school-educational plans, and to promote academic success” (NASN 2015, first paragraph).

Student Condition Treatment Healthcare IHP ECP Notes

(including Provider Order (including school (and other tracking-such as when
medication) given at (treatment/medication, accommodations) to evaluate, date of 504 meeting,
school EAP) etc)

(Y or N or you could (Y, date received or N/A Y or date Y or date

write out what is if no orders needed) developed developed
given)
Example: asthma Y 07/25/19 08/02/19 08/03/19 Evaluate progress 12/1/19
Joe Smith

NASN. (2015). Individualized healthcare plans: The role of the school nurse (Position Statement).
NASN. (2018). School nursing evidence-based practice clinical guideline: Students with seizures and epilepsy. Silver Spring, MD: Author.