Medication Administration
Medication Order Form - for prescriptions medications to be administered at school.
Self Administered Medication Order Form - for certain prescription medications to be administered during school. These may only be medications required for the following:
  • Students with asthma or other respiratory diseases may possess and administer prescription inhalers.
  • Students with medical conditions requiring enzyme supplements may possess and administer them.
  • Students with diabetes may possess and administer glucose monitoring tests and insulin delivery systems.
  • Students with life threatening allergies may possess and administer prescription Epinephrine. (Must also include Allergy Action Plan form)
Allergy Action Plan Form - for the administration of Epinepherine for life threatening allergies
Form for Medication administration on Field Trips

Medication Policy

UNDER NO CIRCUMSTANCE CAN A STUDENT BE IN POSSESION OF “OVER THE COUNTER” OR PRESCRIPTION MEDICATIONS ON THE SCHOOL PREMISES OR WHILE TRAVELING ON SCHOOL SPONSORED FIELD TRIPS.

Our school district requires that the following authorization forms must be completed and returned to the school nurse before a student is given “over the counter” or prescription medicine in school.  The school nurse may delegate the administration of prescription medication only to designated staff on filed trips, if needed.

Over the counter medications: Acetaminophen, Ibuprofen, Anti-Itch Gel, Antacid and First Aid Ointment are available in school and may be given ONLY after parent or guardian permission is obtained. Please refer to the emergency procedure card.

If your child needs a prescription medication to be given during the school day, please submit appropriate forms as soon as possible, so we may begin to give the prescription medication as soon as possible and/or be prepared for any emergency which might arise. 

These permissions must be completed at the beginning of each academic year and renewed as needed:

1.       Registration/Emergency Card – Please note that Acetaminophen (Tylenol), Ibuprofen (Motrin, Advil), anti-itch gel (Calagel), Antacid (Tums), and first aid ointment (Triple Antibiotic Ointment) are supplied by the school and available in the nurse’s office and may be given ONLY after parent or guardian permission is obtained.  Please submit the Registration/Emergency Card on the first day of school.

2.      Prescription Medication Forms:

Medication Order  - For prescribed medications  this form must be filled out and signed by both the prescribing physician and the parent/guardian and returned to the school nurse.

Prescription medications: may be distributed to students by the school nurse when a signed consent by the parent or guardian form is completed and signed prescription medication orders are signed by the medical prescriber and are on file in the nurse’s office. This order MUST be renewed as needed and at the beginning of each academic year.

Medication must be delivered to the school nurse in a pharmacy labeled container by the student’s parent or guardian. No more than a thirty-day supply can be accepted by the nurse.

The first initial dose of a medication cannot be given in school. After a student has been observed to tolerate a medication without side effects or problems at home, subsequent dose may be given at school if necessary.

Medication Order – Self AdministeredFor Inhalers (for asthma or other respiratory disease) and Epi-Pens (for anaphylaxis), Glucose Monitoring Tests,  Insulin (for Diabetes), and Enzyme Supplements (for specific conditions), this form must be completed and signed by both the prescribing physician and the parent/guardian and returned to the school nurse.

Following consultation with the school nurse, students who fall into the following EXCEPTIONS may self-administer prescription medications:

1. Students with asthma or other respiratory diseases may possess and administer prescription inhalers.

2. Students with medical conditions requiring enzyme supplements may possess and administer them.

3. Students with diabetes may possess and administer glucose monitoring tests and insulin delivery systems.

4. Students with life threatening allergies may possess and administer prescription Epinephrine.

Allergy Action Plan - An additional form is required for Epi-pens (anaphylaxis) which must be completed and signed by the prescribing physician and the parent/guardian and returned to the school nurse.