Benicia Unified School District

Chronic Illness Form

The​ ​purpose​ ​of​ ​this​ ​form​ ​is​ ​to​ ​allow​ ​parent​ ​verification​ ​of​ ​absences​ ​related​ ​to​ ​a​ significant documented​ ​medical​ ​condition that is impacts attendance. The​ ​form​ ​eliminates​ ​the​ ​need​ ​for​ ​a​ ​physician’s​ ​note​ ​to​ ​excuse​ ​absences​ ​pertaining​ ​to​ ​the​ ​chronic​ ​illness after​ ​the​ ​limit​ ​of​ ​10​ ​excused​ ​days​ ​has​ ​been​ ​reached.​ ​This​ ​form​ ​does​ ​not​ ​modify​ ​class​ ​work,​ ​tardies​ ​or provide​ ​other​ ​accommodations.​ ​​If​ ​a​ ​student​ ​is​ ​missing​ ​excessive​ ​amounts​ ​of​ ​school​ ​for​ ​medical​ ​reasons, alternative​ ​education​ ​programs​ ​or​ ​modifications​ ​should​ ​be​ ​discussed​ ​with​ ​the​ ​counselor​ ​or​ ​administrator. Medical conditions such as Diabetes, Asthma and seizure disorders generally do not qualify for this.

Home and Hospital

Students who need to be out of school for a minimum of 10 school days for a medical, surgical or psychological treatment which doesn’t allow them to attend school may be eligible for H/H services. H/H is a short term bridge program to assist with work for 1 hr per day while a student can’t attend,  H/H isn’t designed to be a long term program and doesn’ meet their full academic needs, students do the majority of work independently. The student should access google classroom for assignments and email teachers as needed as well as working with the H/H assigned teacher. A physician must complete and sign both the H/H form and cover letter and can either scan, fax or drop off the forms. BUSD has 5 days to find/assign a teacher. Health services initially reviews the forms, Student services arranges and hires the teacher. H/H may be done in the home, a community setting such as the public library or online via zoom or google meet. Schools must always initially try to accommodate students in the least restrictive environment.


School Epi-Pen information

School Districts are required (BP 5141.27) to have epinephrine pens (Epi) on site in the event an undiagnosed student or staff experiences signs/symptoms of anaphylactic reactions. Along with the school nurse and office staff each site may designate one or more school personnel on a voluntary basis to be trained. Students who are identified as having potential allergic reactions should bring their epi pens and medication authorizations to school.


BUSD carries Narcan on each school campus. Narcan (Naloxone) is a nasal spray administered  intranasal in 1 nostril. Narcan can reverse an overdose from opioids including heroin, fentanyl and prescription opioids.

Ca Ed Code now requires all schools to provide information about Type 1 and Type 2 Diabetes.

Required Parent Information for Type 1 and Type 2 Diabetes:

Type 1 (all new students enrolling in public school should receive information about Type 1 Diabetes.)
Type 2 (This information is for all parents of students entering 7th grade)