Health Plans

Any medications that are to be distributed by school staff or used by your student at school must have an Authorization for Medication completed and signed by a licensed provider, including any over-the-counter medications, and be brought in by an adult. A separate Authorization for Medication form must be completed for each medication (only one medication per sheet).

• FARE Food Allergy and Anaphylaxis Emergency Care Plan
• UCS Special Diet Statement form
• 2 Authorization for Medications (one for an antihistamine and one for Epinephrine)
• 2 Transportation Forms (if your child is a bus rider)

Required for Food Services for students with Food Allergies or other health conditions requiring specific meal accommodations.

• Asthma Health Care Plan
• Authorization for Medication for a rescue inhaler
• 2 Transportation Forms (if your child is a bus rider)

• Seizure Health Care Plan
• Authorization for Medication for rescue medications and/or other medications
• 2 Transportation Forms (if your child is a bus rider)

• Diabetes Health Care Plan
• 2 Transportation Forms (if your child is a bus rider)
• Must submit your Diabetes Medical Management Plan from your Endocrinologist

• Heart Condition Health Care Plan
• 2 Transportation Forms (if your child is a bus rider)

• General Health Care Plan
• Authorization for Medication (if needed)
• 2 Transportation Forms (if your child is a bus rider)

Please have your licensed provider complete the below attachment and sign. The form should be returned to the school.

Chrissy Groszkiewicz, RN

christine.groszkiewicz@uticak12.org

586-405-7493

Cluster 1

Beacon Tree, Beck, Crissman, Duncan, Messmore, Morgan, Roberts, Switzer

Malow Jr. High, Shelby Jr. High

Eisenhower High School

Megan Holmes, RN

megan.holmes@uticak12.org

586-980-0731

Cluster 2

Gibbings Preschool

Flickinger, Monfort, West Utica, and Wiley

Eppler Jr. High

Utica High School, IRC, Alternative Learning Center

Walsh Community Education (Day care/preschool and Adult Ed)

Lexy Sorrentino, RN

alexandra.sorrentino@uticak12.org

586-703-0647

Cluster 3

Browning, Dresden, Ebeling, Graebner, Harvey, Havel

Bemis Jr. High

Henry Ford II High School

Emily Duzey, RN

emily.duzey@uticak12.org

586-980-0743

Workdays: Monday, Tuesday, and every other Wednesday

Karolina Dziedzic, RN

karolina.dziedzic@uticak12.org

586-483-9082

Workdays: every other Wednesday, Thursday, Friday

Cluster 4

Burr, Collins, Dekeyser, Oakbrook, Plumbrook (except for POHI/special education students), Schuchard, Schwarzkoff

Davis Jr. High, Jeannette Jr. High

Stevenson High School, UAIS, UCNECT

Tiffanie Polizzi, RN

tiffanie.polizzi@uticak12.org

586-719-2793

Plumbrook POHI and special education students