Form 8a: School Health Care Plan (Page 3 of 4) in pdf

Form 8a: School Health Care Plan Page 3

Appendix 13

Page 3 of 4

Form 8a: School Health Care Plan

Long-term health care requiring medication in school 'as required'

To be completed by parent/carer

Pupil's name:

Date of birth:

I request that the above pupil be given the following medication while at school.

Name of

Date

Dose

Medication to be given if the

Minimum time

between doses

medication

prescribed

following symptoms occur

The GP or hospital doctor has prescribed the above medication. It is in the container in which it was

dispensed, clearly labelled with the contents, dosage and child's name in full.

Name of GP (please print):

Address of GP:

Tel:

I realise that this is not a service that the school is obliged to undertake. I accept full responsibility

for informing the school if my child has been given a dose of this medication before coming to

school. I accept responsibility for ensuring that the medicine has not expired and that there will be

enough medicine supplied to the school for my child's needs. I will collect all unused medicine from

the school at the end of the summer term. I accept that the school will destroy any unused

medication that remains uncollected.

Parent/carer's name:

Address

Tel Home:

Tel Work:

Mobile:

Signature:

Date:

Note: The school will not accept medication unless this form is completed and signed by the

parent/carer of the pupil and the head teacher agrees the administration of the medication. The

head teacher reserves the right to withdraw this service.

City of Edinburgh Council and NHS Lothian

Form 8a: School Health Care Plan Page 3