How Can We Minimise the Risks/Triggers Relating to Your Child's Health Care Needs Or Medical

Medical Risk Minimisation & Communication Plan for Anaphylaxis, Asthma, Diabetes and other medical conditions

This plan is to be completed by the Educator in consultation with child’s parent/guardianon the basis of information from the child’s medical practitioner provided by the parent/guardian.

Child’s name: / Date of birth:
Medical Condition:
Medical Action Plan provided by parent/Guardian: YES NO
Medical Triggers:
Other health conditions:
Medication at service: / Medication Storage:
Have you provided the parent with a copy of the services ‘Medical Condition Policy’?
YES
NO
If No – detail why / Parent/Guardian information (1) / Parent/Guardian information (2)
Name: / Name:
Relationship: / Relationship:
Home phone: / Home phone:
Work phone: / Work phone:
Mobile: / Mobile:
Address: / Address:
Other emergency contacts
(if parent/guardian not available):
Medical practitioner contact:
Emergency care to be
provided at service:
How will the parent/guardian communicate to the educator any changes to medical management plan, child’s condition, expiry of medication or treament of condition?
The following Medical Risk Minimisation Plan has been developed with my knowledge and input and will be reviewed on (record date):
Signature of parent/guardian: / Date:
Signature of educator: / Date:

How can we minimise the risks/triggers relating to your child's health care needs or medical condition? What strategies can we implement to minimise or avoid these triggers?

Trigger/Symptoms/Risks / Source of Exposure / Ellimination/Control measures to be taken

How often does your child display symptoms or suffer from reactions of the medical condition?

Infrequent (5 or less per year)

Occasionally (6 or more per year)

Monthly

Weekly

Daily

When exercising

How do you as a Parent/Guardian recognise the symptoms/reactions?

Is your child always able to recognise the symptoms / reactions? Y N

Details:

Risk / Strategy / Who is Responsible?
What happens if a child’s reliever, medication or spacer are not brought to the service?
How will you ensure the medication stays within the expiry period?
How will you ensure all staff (including relief staff, coordinators and staff, visitors and volunteers) are aware of which children have a medical plan/condition or medication (and location of these)?
How will you ensure you have asthma, anaphylaxis, diabetes or other information available at the service for parents/Guardians?
Is there age appropriate asthma, anaphylaxis or diabetes education for children at the service?
If relevant – how with you ensure the safe handling, preparation, consumption and service of food is developed and implemented?
If relevant, how will you ensure that parents within your service are notified of any known allergens that could pose a risk to this child?
Other:
Other:
Other:
Other: