Medication Forms and 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 your 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.
Medication Form - Prescription and Over the Counter (OTC)
Over the Counter (OTC) Medication: This from must be filled out and signed by parent/gaurdian.
-Medicaiton will be administered according to the manufacturer's suggested dosage for the appropriate age and/or weight. Physician's order required for dosage different from the manufacturer's suggestion.
Prescription Medication: This form must be completed and signed by a medical provider. Parent/guardian must bring the medication in to the school nurse.
1. Any new medication must be started at home before it can be given at school due to possible side effects.
2. Must have written permission by parent/guardian and physician before medicine can be given by nurse at school.
3. All permission forms for medications are good for the current school year.
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. Controlled medications will be counted and stored in a locked cabinet.
7. Students must come to the health room to take medicine.
8. NO NARCOTICS will be administered at school.
**Short-term medications like antibiotics and steroids follow the same rules listed above and can not be transported back and forth each day. It is recommended you speak to the prescribing physician about making the dose and administration times fall outside of the school day.