Asthma HCP

Medication Administration form for inhaler (doctor and guardian fill out/sign)

ROI ( with allergist information)

**Will also need to bring the inhaler to school in original box with prescription label with student's name/info on box

** Can self carry inhaler - will need to get orders from health care provider stating student can self carry and self administer inhaler - inhaler will still need to be in original box with prescription label

FARE form

Medication Administration form for oral allergy meds (Diphenhydramine, Zyrtec, etc)

Medication Administration form for EPI pen

Severe allergy HCP

Dietary Prescription form

Dietary Prescription form instructions

ROI (with allergist information)

** Will also need to bring in EPI pen in original box with prescription label and student's name/info on box as well as diphenhydramine/Zyrtec, etc in original unopened box

FARE form

Medication Administration form for Oral allergy meds (Diphenhydramine, Zyrtec,etc)

Medication Administration form for EPI pen

Severe Allergy HCP

ROI (with allergist information)

** Will also need to bring in EPI pen in original box with prescription label and student's name/info on box as well as diphenhydramine/Zyrtec, etc in original unopened box

Seizure HCP

Medication Administration form (for seizure emergency meds)

ROI

**Also need a seizure action plan from neurologist

** Will also need to bring in emergency seizure medication in original box with prescription label that includes student's name/info on box

Other HCP (for all other health conditions - migraines, urinary, etc)

ROI

Medication Administration Form

**Form needs to be filled out and signed by HCP as well as  signed by guardian in TWO signature areas (For over the counter AND prescription medication)

** Will need seperate form for each medication

** Medication needs to be in original unopened box if it is over the counter medication

**If prescription medication:  Will need to be brought in by guardian to be counted with nurse and initialed