Permission For Medication Form - Department Of Special Education & Student Services
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2Administration of Medication
Administration of medications, especially short term, should be done at home
whenever possible. However, if a student is required to take prescription or non-
prescription medication during the school day, the following guidelines must be met:
A written order from the physician, dentist, or practitioner is required, stating
the student’s name ,the name of medication , the dosage, the time, the route
(oral, injectable, inhaled, patch, etc.),and the duration of time that it is to be
given (e.g., one week, the school year, etc.), along with the
parent’s/guardian’s signature. Medication forms are available for your
convenience in the school clinic.
Medication must be in a container that has been labeled by the pharmacy and
has the most current prescription date. Over-the-counter medication must be
in a sealed, unopened new bottle.
Parent /guardian must deliver medication to the school clinic, as students are
not permitted to transport medication.
All medicine must be picked up by a parent at the end of the school year.
Medicine that is not picked up will be disposed.
In some situations, accommodations can be made for students with asthma and
with potential for severe allergic reactions to self-administer their inhaled asthma
medication or their auto-injectable (Epi-pen) medication. These situations require
written health care plans, along with other specific details for care. Additional
questions and concerns may be directed to the nurse at your school.
Please sign below:
I acknowledge I have read the above information.
______________________
_______________________ ______
Parent/Guardian Print
Parent /Guardian Signature
Date
1A
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Parent category: Medical