Medication Forms

Administration of Medication in County Prep High School & Academy of Technology and Design

If you would like your child to have medication available in school, you and your child's physician must fully complete the following form(s) and return them to the school nurse. (This includes any over the counter medications like Tylenol and Advil).

FOR ASTHMA MEDICATION:
  • Form C: Asthma Action Plan - Please be sure that the physician checks off the box in the lower left hand corner for the student to be allowed to carry and self-administer their medication.

  • Form B: Medication Contract - Front and back must also be completed in order to carry medication.

FOR EPI PEN/LIFE THREATENING ALLERGY:
FOR ALL OTHER MEDICATIONS INCLUDING ANYTHING "OVER THE COUNTER":
  • Form A: Medication Administration Form - If your child requires medication regularly during school hours, you must have your physician fill out the entire form.  You must sign the parent portion and return it with the appropriate medication in a labeled container on the first day of school.  If your child needs to have more than one medication available then one Form A must be completed for each individual medication.
The school nurse is able to administer limited over the counter medications based on the school physician’s standing orders. Please read, complete and return Form E on the first day of school to assist the nurse with this policy.

For students with Diabetes or other chronic medical conditions that may or may not require some form of medication in school, please contact me prior to September so that we may properly ensure that you child’s health needs are met beginning with the first day of school.

All medication must be brought to school in its original container from the pharmacy with the child’s name clearly marked on it. Unless your child has been authorized to carry a life-saving medication, it will be kept locked in the Nurse’s office and will be made available by the school nurse following the physician’s orders.

This form covers your child for the current school year only. New forms must be filled out each new school year. If your child’s physician authorizes any changes in the medication during the current school year a new form must be completed.

Should you have any questions, or need additional forms please feel free to contact me at 201-631-6309.

ALL FORMS INCLUDING THE PHYSICAL ARE DUE ON THE FIRST DAY OF SCHOOL.

Mary McCabe RN
School Nurse
Phone: 201-631-6309
Fax: 201-369-0698