In collaboration with the Fairfax County Health Department (FCHD), Fairfax County Public Schools (FCPS) will be implementing a different asthma care process for students as of the 2022-2023 school year.  The Virginia Asthma Action Plan, developed by the Virginia Asthma Coalition and adopted by the Virginia Department of Education (VDOE), will be used as a guide to providing safe and accurate asthma care.  The Virginia Asthma Action Plan is critical for the communication and coordination of asthma treatment between the health care provider, parent/legal guardian, and the school.  The previous FCPS Inhaler Authorization form will no longer be accepted.

• Virginia Asthma Action Plan - Parent/legal guardians of students with a prescription for asthma rescue medication must provide to the school the Virginia Asthma Action Plan with each portion completed including the following:
  • Top portion of the form – completed by the parent/legal guardian
  • The remainder of the form – completed by a health care provider who is licensed to prescribe medication in the United States
    • If the prescriber approves the student to carry and administer the medication, the appropriate box above where the prescriber signs must be checked.
  • The parent/legal guardian must also sign this document.
     
• FCPS Authorization for Virginia Asthma Action Plan form (SS/SE-65) - This form authorizes the designated school staff, the School Health Aide (SHA), or the Public Health Nurse (PHN) to administer the asthma rescue medication to the student, as directed by the health care provider, on the Virginia Asthma Action Plan.  When the parent/legal guardian brings the student’s asthma rescue medication to the school, they will be provided a hard copy of the FCPS Authorization for Virginia Asthma Action Plan form (SS/SE-65).  Each part of this form must be completed including the following:
  • Part I – completed and signed by the parent/legal guardian
  • Part II – signed by the parent/legal guardian and the student ONLY if the student is approved to self-carry the medication
  • Part III – completed by the principal or principal designee

Please reach out to your school public health nurse for any questions or concerns.