Required Documents
A variety of clinic forms must be completed following the LRE Options IEP Meeting if TSB is determined to be a student's LRE educational placement. These forms are included below in two separate PDF documents for families to reference and must be returned before the Final Placement IEP Meeting can be held. The school registration packet is shared at the Final Placement IEP meeting, to be brought to school by a parent/guardian on the student's start date.
In addition, the following must be provided as well:
- Birth certificate or officially acceptable evidence of date of birth
- TN Immunization Record
Clinic Registration Packet
Some forms must be completed by the student's medical provider.
- Clinic Welcome Letter
- TSB Clinic Guidelines
- Medical History Form
- TSB Clinic Consents Form
- Concussion Questionnaire & Health Care Providers Form
- Over the Counter Medications Consent Form
- TSB Physical Exam Form with Medications List
- Health Care Provider Medication Order Form
Emergency Care Plans
All applicable care plans must be filled out.
- Seizure Care Plan
- Medication Pump Care Plan
- Diabetes Mellitus Care Plan
- Diabetes Insipidus Care Plan
- Baclofen Pump Care Plan
- Abdominal Tube Care Plan
- Asthma Care Plan
- Allergy and Anaphylaxis Emergency Plan
- Adrenal Insufficiency Care Plan
- Shunt Care Plan