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Medication Forms

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Medication Authorization Form

  • This form is required for a student to take medication in school.  This includes any prescription medication, over the counter medications, inhalers, epipens and insulin.
  • It must by signed by BOTH parent/guardian and physician.
  • Students who self carry inhalers, epipens or insulin must also complete this form. 
  • Students may only self carry insulin, epipens and inhalers. A Medication Authorization form is required with the physician indicating the student is capable and responsible to self carry.  Any other medications (including over the counter) MUST be kept in the nurse's office.
  • All medications must be supplied by the parent/guardian. 
  • Medications must be in the original container with prescription label.  Over the counter medications must also be supplied to the nurse in it's original container.

Asthma Form

  • The Asthma Action Plan is required for all students with asthma along with the medication authorization form above.
  • It is to be completed by a Parent/Guardian and Physician