Forms for Education

The forms listed on this page are intended to be samples that can be adapted for states and Local Education Authorities (LEAs), usually school districts or charter schools.

Along with the forms in the Resources section below, the following pages in the Medical Home Portal may be helpful:


Information & Support

For Parents and Patients

Medical Home to School Summary Form (PDF Document 40 KB)
Sample form for communication between health care providers and schools about health concerns that impact a student's education.

Medical Home - School Information Release Form (PDF Document 49 KB)
Sample form for a child's parent/guardian to authorize two-way communication between the health care provider and school team.

Accommodating Children with Special Dietary Needs in the School Nutrition Programs (PDF Document 849 KB)
Gives a useful guide for nutrition accommodations, including information about modifying school meals for students with disabilities and other dietary requirements such as food allergies.

School Contacts Page 1 (Care Notebook) (PDF Document 66 KB)
A place to list the school district, special education coordinator, 504 Accommodation Plan coordinator, district nurse for the school, care provider, and school/preschool. This is part of the Care Notebook Contacts Section.

School Contacts Page 2 (Care Notebook) (PDF Document 62 KB)
A form to list the school principal/administrator, classroom teacher, resource instructor, aide/assistant/intervener, special education director, special education teacher, therapists, and other contacts. This is part of the Care Notebook Contacts Section.

Personal Portfolio Manual (PDF Document 151 KB)
P.R.O. filer - Personal Portfolio and Filing System (2000) gives a helpful guide to organizing documents for youth and young adults with disabilities. Published by the Institute on Community Integration.

Authors & Reviewers

Initial publication: July 2008; last update/revision: August 2023
Current Authors and Reviewers:
Author: Alfred N. Romeo, RN, PhD
Reviewer: Shena McAuliffe, MFA