BROCK ISD GUIDELINES FOR ADMINISTRATION OF MEDICATIONS AT SCHOOL

All medications should be given at home if possible including the first dose of any medication.  Administration time of medications should be adjusted so that only one dose will need to be administered at school.  All medications must be checked in and given directly to the school nurse.  The School Nurse has discretion to use her professional judgment in medication administration.

The parent is responsible for the transportation of the medication to and from school.  The school district cannot assume any responsibility for medication carried to school by the student.  Medication not picked up at the end of the school year will be discarded.  Upper level students may transport medication home at the end of the school year with a permission slip from their parent or guardian.

1. All Prescriptions medications must be:

• Provided by the parent/guardian and accompanied by a signed permission slip

• Be in it’s original container, properly labeled

• Inhalers must be kept in the nurse’s office.  A student may only carry an inhaler if a physicians order is provided to the school.  In the event that a student must carry an inhaler, an additional inhaler should be kept in the school nurses office and an Inhalers Administration Request Form should be signed.

2. All over the counter medications must be:

• Provided by parent/guardian and accompanied by a signed permission slip
• Be in it’s original container and be age appropriate given only according to label directions
• Will not be given more than 10 consecutive days without a physicians order

3. All sample prescription medications must be:

• Provided by parent/guardian and accompanied by a signed permission slip
• In its original container and only be administered with a physicians order

4. All Alternative medicine must be:

• Provided by parent/guardian and accompanied by a signed permission slip
• In its original container, accompanied by a parent information sheet listing ingredients, actions and side effects.
• Will only be given with a physicians order including dosage information

5. The District cannot assume ANY responsibility for loss or negligent behavior when a student carries his/her medication without knowledge of the nurse.

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PARENTAL PERMISSION FOR ADMINISTRATION OF MEDICATION DURING SCHOOL HOURS

                                                                                                               DATE: ____________________

STUDENT_________________________________                           DOB:  ____________________

In order for the above student to remain in school, it is necessary that the following medications be given during school hours as directed.

NAME OF MEDICATION: _________________________________________________________________

DIRECTIONS: ____________________________________________________________________________

I HERBY REQUEST THAT THE MEDICATION SPECIFIED ABOVE BE ADMINISTERED TO THE ABOVE NAMED STUDENT.                 

   SIGNATURE OF PARENT/GUARDIAN: __________________________________DATE: ________

INHALER(S) ADMINISTRATION REQUEST

DATE: ______________________________SCHOOL: ___________________________________________

We, the undersigned parents/guardians of _________________________________request that our child be allowed to keep the prescribed inhaler(s) on her/her person at all times and to self-administer medication as requested by the physician.

We understand that it is the student’s sole responsibility to keep the inhaler(s) on his/her person.  If they are misplaced or used by other students, this privilege will be revoked.  We also understand that the inhaler(s) must be properly labeled with a prescription label.

Signature of Parent/Guardian: __________________________________________________________

PHYSICIAN REQUEST

You are hereby authorized to allow _____________________________________to carry the prescribed inhaler(s) on his/her person at all times and self-administer medication due to the student’s asthma.

Name of Inhaler(s) ___________________________________________________________________

Dosage and Time of Administration ______________________________________________________

Period for which medication will be required _______________________________________________

Signature of Physician _________________________________________________________________