Medical Forms2018-10-18T11:00:23+00:00

Medical Forms

Authorization for the Possession and Use of Asthma Inhalers, EPI-Pens, and Emergency Medications

Medication Authorization

Before any medication can be given, the Medication Request and Authorization Form must be filed with the office before a student will be allowed to begin taking any medication during school hours

This written and signed request form is to be submitted on an annual basis.  Parents should determine with their doctor’s counsel whether the medication schedule can be adjusted to avoid administering medication during school hours.  Medication may be administered to a student while under the jurisdiction of the school according to the following guidelines established by the Board of Education:

  • No medication shall be administered unless it shall appear that the administration of such medication during school hours is necessary for the health and well-being of the student.
  • Medication may be administered only on the written authorization of a student’s parents or guardian.  The authorization shall include a written statement from the prescribing doctor stating the student’s name, date of prescription, the name of the medication, dosage, and frequency taken (including the date or time when medication shall be terminated) together with any special instructions.
  • All medications shall be in a suitable container and shall bear the student’s name, the name of the medication, instructions for the administration of the medication, and the name and phone number of the pharmacy.  The preparation of the medication shall not require any special skills.
  • All medication is secured in the Office.
  • Medication is administered in the school office by an adult designated by the school administrator.
  • Elementary students may not administer any medication of any kind to themselves or to another student.
  • Records of when the medication was administered by the school are kept in the school office.

Consent for Disclosure of Immunization Information

As of August 23, 2018, this is a new requirement of schools to be in compliance with the Family Educational Rights and Privacy Act (FERPA), 20 U.S.C (1232g).  If you choose to withdraw your consent to report immunizations to the Local and State Health Departments, please sign and return this form to your child’s school.

Consent for Disclosure of Immunization Information