Form 400-23 - Medication Authorization Form (Page 2 of 2) in pdf

Exhibit 1 (continued) Reg. No. 400-23

IMPORTANT INFORMATION

for Parents/Guardians and Health Care Providers

1. Please give your child needed medication at home if at all possible

2. It is recommended that the first full day’s (24 hours) dose of any new medication be given at home. If unsure,

follow the recommendation of health care provider about attending school during the first 24 hours.

3. If it is absolutely necessary for the student to take prescription, over-the counter or alternative medication at school

or on field trips, this Medication Authorization form must be completed for each medication and submitted to the

school health staff prior to medication being given at school.

4. Medications:

a. Prescription medication(s) must be in a container labeled by the pharmacist with the student’s name, prescriber’s

name, name of medication, dosage, route, directions for administration, conditions for storage, prescription date

and expiration date. Maryland law allows prescription medication to be used only for 1 year beyond date of issue

or expiration date indicated on the medication—whichever comes first.

b. Over-the-counter medication(s) must be provided to the school in the original sealed container.

5. Parent/guardian responsibilities:

a. Provide a new medication prior to the expiration date on the pharmacy label or the over-the-counter medication

container.

b. Provide the medication(s) for the duration of the order.

c. Bring the medication to school. FCPS regulation 400-23 states that students are not permitted to transport

medications, unless authorized to self-carry.

d. Retrieve any unused or discontinued medication(s). No medications will be sent home with students.

6. Student Self-Carry and/or Self-Administer:

a. The health care provider and registered nurse must indicate whether the student is competent to self- administer

and/or self-carry, if needed.

b. If competent to self-carry and/or self-administer, the registered nurse will work with the student and

parent/guardian to develop a Plan for Medication/Treatment Management Outside the Health Room.

7. The registered nurse must review and approve these forms prior to administration.

Form 400-23 - Medication Authorization Form Page 2