If your child requires medication during school hours, the following protocol is necessary:

• Complete and submit this form.
• All medication brought to school must be given to the nurse.
• If medication is to be given for more than one day, A DOCTOR’S NOTE IS NECESSARY. Medications will not be given beyond the first day without this note.
• ALL medications, both over-the-counter and doctor-prescribed, must be accompanied by a parent’s signature. (Filling out the form on the other side will suffice, or a personal note). The note must state the name of the medication, reason for taking it, dosage, time, and directions for administration (i.e., by mouth, mix with food, take with juice, etc.)
• ALL medications MUST BE IN THE ORIGINAL LABELED CONTAINER. We cannot accept any medication that is not sent in this way. (If you ask the Pharmacist, most will give you an extra labeled bottle)
• For all severe food/anaphylaxis allergies, the Food Allergy Action Plan must be completed and accompany all prescribed medications.
• A parent or guardian should deliver the medication. When this is not possible, the medication must be sent in a sealed envelope. Please notify the nurse by phone of the number of pills or amount of liquid you have sent.
• If any changes are to be made to the dosage or time to be given, a note from the prescribing physician and parents is needed before any changes are made at the school.

These guidelines may also be found in the School District Handbook under ADMINISTRATION OF MEDICATION and are necessary in order to ensure your child’s safety. Please feel free to call me if you have any questions.