Sickle Cell Anemia (SCA) Action Plan OVER (revised 32709) All current medications Name of Medication 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student information, including the student's name, date of birth, grade, and ID number in the designated fields.
3. Fill out the emergency contact section with details for both parents/guardians and any additional emergency contacts. Ensure all phone numbers are accurate.
4. In the SCA Emergency Action section, list symptoms of a painful episode and signs that require medical attention. This helps caregivers respond effectively.
5. Complete the 'All current medications' section by listing each medication's name, dosage, and time it should be administered. Include any medications that need to be given at school.
6. Provide any additional information for the school nurse regarding fluid requirements or other specific needs in the designated area.
7. If applicable, note any physical education limitations as advised by a physician.
8. Finally, ensure that both parent/guardian signatures are obtained along with the date for acknowledgment.

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