Medical Condition:
Description of medical condition: (Triggers- if applicable, preventative actions)
Signs and Symptoms

Actions to manage the medical condition/ presenting symptoms	Medication
Name	Frequency	Dose	Method
Possible side effects of medication:

First Aid / Emergency Treatment	Phone 000 for an ambulance

Comments

Emergency contact name:
Phone:

Doctor / specialist name:
Phone:	Date*:	Signature:

*This Medical Management Plan must be reviewed when medical needs change or every 18 months.