Clinic Forms
In order for your child to take medication during the school day the following steps must be completed:
1. A Medication Authorization Form is required for any and all medication that is to be given at school. This includes both prescription medication as well as over the counter medication.
2. The Medication Authorization Form must be completed and signed by a physician and a parent.
3. All medication must be brought in to the school by an adult. No child shall carry medication to or from school, unless it is an inhaler or an Epi pen and the proper paperwork is in place prior to them having it.
4. No medication should be sent with a child on the bus.
5. All medication must be in the original container and clearly labeled with the student’s name.
6. All prescription medication must be in the original container with a current medication label. The label must contain the student’s name, the drug name and dosage, and the correct dosing information.
7. Parents are responsible for cutting any pills that require being split.
8. Parents are responsible for providing any medication measuring spoons or cups for a medication.
9. The school does not supply any medications to the students (Acetaminophen, cough drops, eye drops, ointments, etc.)
10. No medication will be accepted at the school prior to the paperwork being completed and on file.
Below is a list of Authorization forms that are required should your child need to have a medication administered during school hours. Contact the school clinic with any questions regarding these forms.
PRESCRIPTION AND OVER THE COUNTER MEDICINES
If your child is in need of receiving any medication during school hours please complete the Medication Authorization form below . Return the form to the clinic along with the medication in it's original container and your child's name clearly marked on it. This includes all prescription as well as over the counter medications.
Medication Authorization Form
ASTHMA INHALERS
If your child has Asthma and needs to have an inhaler at school please have a physician complete and sign the Asthma Action Plan listed below. Return the form to the clinic.
Asthma Action Plan
LIFE THREATENING ALLERGIES
If your child has a severe, potentially life threatening allergy please complete the Allergy Action Plan form below and return it to the clinic along with any medications that may be prescribed by a doctor.
Allergy Action Plan
If your child will be carrying their Epi pen on themselves and administering it please complete the Self Carry Epi Pen Administration form below. Please note on the form that the law states that you must provide the school with a back up Epi Pen to be kept in the clinic in the event that your child does not have their Epi Pen with them
Self Carry Epi Pen Administration Form
STUDENTS WITH SEIZURES
If your child has a seizure disorder please complete the Parent questionnaire below and have a physician complete and sign the Seizure Action Plan below. Return both forms to school so that we can provide the appropriate care for your child should they have a seizure at school.
Parent Questionnaire Regarding Seizures
Seizure Action Plan
