PDF DocumentMedication Permission Form

Procedures for administering student medication:

Definition:  Medication includes both prescription and non-prescription medications or homeopathic remedies and includes those taken by mouth, taken by inhaler, which are injectable, applied as drops to eye or nose, or applied to the skin.

1. No medication or homeopathic remedies will be given without written authorization from both parent and physician. Medication authorization forms are available in the office.

2. The student's parent/guardian must provide the school with written permission and request to administer medication.

3. A written order from the physician must accompany the medication and include the following:

  • student's name
  • Name of medication
  • Dosage
  • Time to administer (specific time of day or emergency circumstance)
  • Route of medication
  • Duration of administration
  • Reason for medication (diagnosis and anticipated effect)
  • Undesired side effects

4. A Medication Authorization form must be renewed each school year. Parental or guardian request/permission and physician's instructions are valid for the current school year only.

5. Medication shall be transported to and from school by the parent/guardian unless other safe arrangements are necessary and are made in advance with the school.

6. A physician's written order is required for a change in medication dosage or time of administration.

7. Injectable medication may be self-administered. If the student has an emergency medication to be administered by injection and cannot personally inject it, EMS will be called to the scene. School personnel will not be expected to administer subcutaneous or intramuscular injections not supplied in auto-pen form.

8. Prescription and medication supply renewal shall be the responsibility of the parent/guardian.

Procedures for student self-administration/self possession of inhalers or emergency medication only:

Definition: Self-administration means that the student is able to administer medication in the manner directed by the physician without additional assistance or direction. Self-possession means that under the direction of the physician, the student may carry medication on his/her person to allow for immediate and self-determined administration.

1. The student's parent/guardian must provide written permission and request to the school to allow the student to self-possess and self-administer inhalers or emergency medications.

2. Written instructions which include name of student, name of medication, dosage, time to be administered, route of administration, duration of administration, and the physician/provider instruction that the student may self-possess and/or self-administer must be provided to the school.

3. A Medication Authorization form must be renewed each school year. Parental or guardian request/permission and physician's instruction are valid for the current school year only.

4. All medication shall be kept in a labeled container as prepared by a pharmacy or pharmaceutical company and labeled with dosage and frequency of administration. This language also pertains to refills.