Medication Forms

Medications In School

Students are NEVER allowed to carry or take any medication on their own at school except for the few life saving medications noted.
All medication orders expire at the end of a school year. Medications needed during school hours MUST be reordered in the summer and supplied to the school before the start of each new school year in September.
Students with orders for emergency Asthma inhalers or EpiPens who plan to participate in after-school sports, MUST have current orders stating they are allowed to carry their own inhaler or EpiPen, in order to participate.

General Medications

If a student requires medication during school hours, the appropriate form(s) must be completed and signed by the student's health care provider and parent. Once completed and signed, an adult must bring the forms and the medication to the school where it will be kept in the Nurse’s Office. All medication must be unexpired and in its original packaging with the pharmacy prescription label intact. The student will be responsible to come to the Nurse’s Office at the specified time when the medication will be dispensed by the nurse. Any unused medication must be picked up by an adult at the end of the school year, or it will be discarded.

Medication Permission Form

Asthma Emergency Medication

Any student with a diagnosis of Asthma must have an Asthma Treatment Plan completed and signed by the student’s health care provider and parent. If the doctor and parent both agree and sign that the student is capable of carrying and giving their own emergency inhaler, then the student must bring the completed forms and inhaler medication to the school nurse for review. Once reviewed with the student, the student will be required to keep the labeled inhaler in their book bag to be used as needed. All school staff are trained in the basics of Asthma and inhaler medications for support. The student should continue to access the school nurse as needed for Asthma symptoms and assistance.

Asthma Action Plan

Anaphylaxis (EpiPen) Medication

Any student with an allergy that their doctor has deemed has the potential for a life threatening reaction (anaphylaxis), must have an Allergy Action Plan completed and signed by the student’s health care provider and parent. If both the doctor and parent agree that the student is capable of carrying and giving their own epinephrine auto-injector (EpiPen), then the student must bring them, along with the signed order forms, to the school nurse for review. After review, the student will be required to keep the EpiPens in their book bag for use if needed. School staff are trained in the recognition of an allergic reaction. School staff EpiPen delegates and the school nurse will be available to provide first aid and assistance as needed for any allergic reaction. EpiPens must be in the original box with the pharmacy prescription label intact, and must not be expired. Both devices must be included in case of a rebound reaction requiring a second dose of epinephrine.

Epinephrine Allergy Action Plan

Diabetes Medications

Any student with insulin dependent Type 1 Diabetes is permitted to carry their own insulin supplies with them in their book bag. A Diabetes Health Care Plan, or the equivalent information in orders provided by the student’s health care provider, must be supplied to the school and reviewed with the parent, student, and school nurse. The parent must supply carbohydrate snacks and diabetic supplies and medications to be stored in the school Nurse’s Office.

Diabetes Individualized Care Plan