Medication shall be administered only when the student's health requires that it be given during school hours. It is the parent/guardian's responsibility to bring the medication to school and remove any unused medication when treatment is completed.
All prescription medication must be brought to school in the original container. The pharmacy label must include the following information:
Name of student
Prescription Number
Name of medication and dosage
Administration route or other directions
Date
Licensed prescriber's name
Pharmacy name, address, and phone number
All non-prescription midication must be brought to schol in the original manufacturer's labeled container with the ingredients listed and the child's name affixed to the container.
No more that one month's supply of any medication should be brought to school.
Student's Name_________________________________________________
School__________________________ Grade ________________________
I request that school personnel assist the above named student to self-administer the following medication while in school and away from school for school activities.
Name of Medication:______________________ Amount to be taken: ________
How medication is to be taken ( orally, topically, inhalation, injection ) __________
Time(s) medication is to be taken: _____________________________________
Reason medication is needed at school: _________________________________
Parent/Guardian Signature ___________________________________________