Clone of Medical Management Plan

Metella Road OOSH Medical Management Plan

The service Medical Management Plan includes sections to outline the details,symptoms, and triggers of medical conditions, as well as steps to manage them.If some areas do not apply to your child, please leave them blank.
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Photo of Child (Please ensure this is a recent and clear image of their face)

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Medicare Number
Diagnosed Medical Condition/s
Details, Symptoms and Triggers of Medical Condition/s
Step by step action to be taken: Please also attach Action Plan (eg. ASCIA) below if required.
If Anaphylaxis, list the confirmed allergies
Medication to be administered IF APPLICABLE (name of medication, dose and method of application, frequency of application, further instructions)
Steps to take if symptoms do not improve
For children at risk of anaphylaxis, the ASCIA Action Plan for anaphylaxis is the emergency response plan. This plan is obtained by the parent from the child's doctor and a copy must be provided to the service.
Parent/Guardian Contact Details 1

First NameLast Name
Mobile
Work or Home Phone
Parent/Guardian Contact Details 2

First NameLast Name
Mobile
Work or Home Phone
Medical Practitioner/Doctor Name

First NameLast Name
Medical Practitioner/Doctor Phone
Medical Practitioner/Doctor Address

Street Address

Street Address Line 2

CityState

Postcode
Special medical notes (IF APPLICABLE)
ASCIA Action Plan for Anaphylaxis, Asthma Management Plan, Any other medical files or reports which maybe relevant.

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The Australasian Society of Clinical Immunology and Allergy (ASCIA), recommend that Medical Management Plans, including Asthma and Anaphylaxis Action Plans, be displayed in areas that can be accessed by staff easily and quickly if an emergency response is required. As an approved Early Childhood Education and Care service, however, we have a responsibility to comply with Privacy Laws.

The Privacy Laws protect personal and health information by setting standards on how it should be handled from collection to disposal. Medical Management Plans contain personal health information about your child, and this is readily visible for other people who access our Service.

We are required to inform our families and seek permission to display your child’s Medical Management Plan in the centre office and food preparation areas.
I understand the privacy considerations revealed for my child and provide permission for my child's ASCIA Asthma or Anaphylaxis Plan containing their name, photograph and relevent treatment details to be displayed in the centre office and food preparation areas.
Permission to display
Name of Parent/Guardian completing this form

First NameLast Name
Signature
OFFICE USE ONLY
Nominated Supervisor's Name

First NameLast Name
Signature
Should be Empty:

Metella Road OOSH Medical Management Plan