Permission to Self Carry Medication Form "1"
There are 2 forms necessary for this process
by Katie Kettler
January 15, 2007
USD 415
HIAWATHASCHOOL DISTRICT
MEDICATION AT SCHOOL
School nurses follow special regulations in order to safely and legally administer medication at school. Medication (with the proper paperwork) will be administered to relieve pain that may be a result of orthodontic work (braces) or in case of injury (broken bone) but will not be given to relieve fever so that the child can remain in school. Children should stay home until they are temperature free (without medication) for 24 hours. Sending them to school sooner may slow their recovery as well as expose other children to unnecessary illness. Please read the following guidelines and keep them in a convenient place for future reference. Medication not meeting these guidelines can not be given.
NON PRESCRIPTION (OVER THE COUTNER) MEDICATION- This includes Tylenol, cold tablets, Ibuprofen (Motrin), cough syrup, etc. The parent’s and the physician’s signature and the original bottle providing current and accurate information is required.
PRESCRIPTION MEDICATION- This includes medication to be given for each condition such as asthma, seizures, and ADHD. The parent’s signature and bottle with a pharmacy label with current and accurate information, and a physician’s signature is required. The Request to Administer Medication at School forms are available in the school health room. Ask the pharmacist to put the medication in two bottles: one for school and one for home.
IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE SCHOOL NURSE BEFORE SENDING THE MEDICATION TO SCHOOL.
The lawful custodian will send the medication in an original container, which identifies the name of the pupil to receive the medication and the name of and proper dosage of medication.
ANY ABUSE OF A SELF-ADMINISTRATION PLAN WILL RESULT IN THE LOSS OF PRIVILEGE.
Signature of Parent ____________________________________ Date _______________
Signature of Student: __________________________________ Date _______________
Signature of School Nurse: ______________________________ Date _______________
IMPORTANT NOTE: In order for a student to have access to an inhaler at all times, it is recommended that one inhaler be kept by the school nurse as a back up to the one carried by the student.
