Health and Medication Forms
Medication Forms
Medication administration, whether prescribed or over-the-counter, during school hours, is as follows:
Medication must be accompanied by a medication permission form signed by both the healthcare provider and parent/guardian.
For short-term medications such as antibiotics, the prescription label on the bottle is acceptable for a physician's order with the medication permission form or a written permission statement by the parent.
Nurses can provide acetaminophen (Tylenol) and ibuprofen (Motrin) under the direction of the school physician and with permission from the parent/guardian via the SNAP Parent/Guardian Portal.
Faxed orders will be accepted if received directly from a physician's office.
Nurses will contact physicians directly if there are any questions about a medication order.
Medication must be supplied by the parent/guardian in the original pharmacy container. Please ask your pharmacist to provide a second container and send only the amount of medication needed for a one-month. Medication is kept locked in the nurse's office and is dispensed by the school nurse.
For your child's safety and the safety of other students, students are not allowed to carry medication to school. When a parent/guardian deems it necessary for a student to have immediate access to medication, the school nurse must agree that it is safe and necessary for the student to carry and self-administer. The school nurse, parent, and student will need to enter into an agreement that specifies the conditions under which the prescription medication may be self-administered.
Investigational new drugs with FDA approval may be administered in the schools with a written order by a licensed prescriber, written consent of the parent/guardian, and a pharmacy-labeled container for dispensing. If there is a question, the school nurse may seek consultation and/or approval from the school physician to administer the medication in the school setting.
The parent/guardian may retrieve the medicine from school at any time. The medicine will be destroyed if it is not picked up within one week following termination of the order, or one week beyond the close of the school year.
Field Trips: School nurses are rarely available on field trips. EpiPens go on all field trips and staff are trained to administer them. Benadryl does not go out on field trips per Massachusetts Department of Public Health regulations. When no nurse is present on a field trip, students will receive medications as follows: 1) A staff member, delegated by the school nurse, will administer the medication if permitted by Massachusetts DPH regulations or 2) With out-of-state field trips, a student may take the medication from a labeled pharmacy bottle if age appropriate. The staff member will hold the medication for safekeeping when appropriate.
*Please open the forms below, click File and Make a Copy in order to edit them.