Medical Plan Information

Havel Elementary

Our mission it to educate students, promote life long learning and encourage students to become productive citizens within a positive and safe learning environment.

Medical Plan information

Dear Havel Parents,


Utica Community Schools are committed to providing a healthy and safe environment for each of our students. A health plan is required to be completed at the beginning of every school year. For your child's safety we ask that all health forms are turned in prior to the first day of school, August 31st, 2021.


Health plans should be completed for any condition that may involve special dietary considerations, activity levels, medications, or treatment of urgent problems. Completion of health plans allows our staff to take the best possible care of your child.

A physician signature is required on all health plans. Any medications that are to be distributed by school staff or used by student at school must have an Authorization for Medication completed and signed by a physician, including any over-the-counter medications.


Health Care Plans and Authorization for Medication forms are available at https://www.uticak12.org/cms/One.aspx?portalId=578321&pageId=5042259. Two transportation forms are required for every student that rides the bus with a COLOR picture attached to each form. Depending on your child’s diagnosis, the following forms are required by the school:


· Food Allergies/Insect Allergies/Latex Allergies: FARE Food Allergy and Anaphylaxis Emergency Care Plan, Michigan Department of Education Medical Statement to Request Special Meals and/or Accommodations, 2 Authorization for Medications (one for an anti-histamine and one for Epinephrine), 2 Transportation Forms (if your child is a bus rider)


· MDE Dietary Accommodations: Required for Food Services for students with Food Allergies.


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


· Seizure: 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: Diabetes Health Care Plan, 2 Transportation Forms (if your child is a bus rider) and you must submit your Diabetes Medical Management Plan from your Endocrinologist


· Heart Condition: Heart Condition Health Care Plan and 2 Transportation Forms (if your child is a bus rider).


· Any other diagnosis: General Health Care Plan, Authorization for Medication (if needed), 2 Transportation Forms (if your child is a bus rider)


Please return all the necessary, completed and signed forms (dated after June 11th) prior to August 31st, 2021 to: officehavel@uticak12.org


Your cooperation will help ensure a safe and healthy school year. Any questions can be directed to: Rebecca Rosbolt, BSN, RN, Utica Community School’s District Nurse rebecca.rosbolt@uticak12.org

Health Care Plan No Longer Needed

If your child no longer needs a health plan on file we need you to please complete the document below and email it to officehavel@uticak12.org

Food Services Allergen Form

We take food allergies and student safety very seriously. If your student has any food allergies please have your physician fill out the MDE Dietary Needs Form and return it to the food service office. We are happy to work with parents and students to help accommodate your needs. For questions about food allergies and menu selections please call our office at 586-797-1180.