Field Trip Medication Administration Form Page 2
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1
2PROCEDURE FOR ADMINISTRATION OF MEDICATION DURING FIELD TRIP
1. Parent to obtain “Medication Administration Consent Form” from school office. Form to be
completed by parent and physician and returned to school office.
2. Parent to obtain and complete “Field Trip Medication Administration” form and return to school
office along with “Medication Administration Consent Form” for each medication to be given
during field trip.
3. Parent to bring medication to school office, in pharmacy labeled container with instructions the
same as what is written on the two consent forms. Quantity of medication should only be what is
to be administered on the field trip. Over the counter medications must be labeled with students
name.
4. If a “Medication Administration Consent Form” is already at the school site, a photo copy is given
to the teacher along with the “Field Trip Medication Administration” form.
5. If a student has an Action Plan already in place at school, i.e. Asthma Action Plan, Diabetic Action
Plan, Moderate-Severe Allergy Action Plan, a photo copy will be given to the teacher.
6. Teacher will be in-serviced on administration of medications by school nurse.
7. Students requiring any medications taken other than by mouth, topically or via inhaler, or students
requiring any Specialized Health Care Procedure (Nebulizers, Insulin, gastrostomy tube
administration, etc.) MUST notify the School Nurse (828-2551 ext. 8036) at least 10 days prior to
field trip date so that procedures can be written and approved by physician and parent. Upon
receipt of written procedures, Teacher will be trained by Nurse/Physician prior to student attending
field trip. In the event that the above is not done by the above deadline, the parent/guardian will
be responsible for administration of medication while student is on field trip.
8. Teacher will have on the field trip:
a. “Medication Administration Consent Form” for each medication to be given.
b. “Field Trip Medication Administration” form.
c. Action Plan if necessary.
d. Medication in pharmacy/ original over the counter, labeled container.
9. Teacher will administer medication according to “5 Rights of Medication Administration”
Right Student
Right Medication
Right Dosage
Right Time
Right Route
10. Upon returning to school, Teacher will return medication and “Field Trip Medication
Administration” form, and copies of medication forms/Action Plans to Health Clerk to file in
student’s health folder.
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