Medication Forms & Questionnaires

• Nut Allergy Form

  Please fill this form out if your child has a nut allergy. I would like for you to list safe snacks and treats for your child to have while at school. Also check if you would like for your child to sit at the Nut Free Table for lunch. 

• Asthma Questionnaire

  If your child has been diagnosed with Asthma, please fill out a questionnaire and turn it in to the health room. Even if your child will not be keeping an inhaler or nebulizer treatment at school, I'd like to have a questionnaire on file for them. I like to have an updated questionnaire every year. 

• Seizure Questionnaire

  If your child has been diagnosed with a seizure disorder, please fill out a questionnaire and turn it in to the health room. Even if your child will not be keeping a medication at school, I'd like to have a questionnaire on file for them. I like to have an updated questionnaire every year.

  Severe Food Allergy Questionnaire

  If your child has been diagnosed with an allergy whether it is severe or mild, please fill out a questionnaire and turn it in to the health room. Even if your child will not be keeping a medication at school, I'd like to have a questionnaire on file for them. I like to have an updated questionnaire every year. If you child will have an epinephrine pen at school, a prescription medication form will be needed. 

• Severe Insect Allergy Questionniare

  If your child has been diagnosed with an insect allergy, please fill out a questionnaire and turn it in to the health room. Even if your child will not be keeping a medicine at school, I'd like to have a questionnaire on file for them. I like to have an updated questionnaire every year. If you child will have an epinephrine pen at school, a prescription medication form will be needed

• Specialized Health Care Procedure Form

  This form is for any specialized health care procedure to be performed at school. This form must be completed by a medical provider

• Over the Counter (OTC) Medication Form

  -Over the counter medication form to be filled out by parent and signed by parent. 

  -Medication will be administered according to manufacturer's suggested dosage for appropriate age and/or weight. Physician's order required for dosage different from manufacturer's suggestion

• Prescription Medication Form

  Your school nurse is aware there are circumstances and health conditions when students require medications during the school hours or need to have emergency medications available at school.

  Any new medication must be started at home before it can be given at schoo due to possible side effects.

  All medicines, prescription and non-prescription (OTC), must have a permission form on file in the health room.

  1. All permission forms for medications are good for the current school year.

  2. All controlled medications, including ADHD medicines, should be brought to school nurse by a parent/guardian.

  3. Must have written permission by parent/guardian and physician before medicine can be given by nurse at school.

  4. Any change in dosage or time to be given will require a new written permission by the physician.

  5. Must have a current pharmacy label on bottle.

  6. Medication will be counted and stored in a locked cabinet.

  7. Students must come to the health room to take medicine.

  8. If not picked up, medicine will be destroyed on the last day of school.

  9. NO NARCOTICS will be administered at school.

   

  **Short-term medications like antibiotics and steriods follow the same rules listed above and can not be transported back and forth each day. It is recommended you speak to the prescribing physican about making the dose and administration times fall outside of the school day.