Authorization to Administer Prescribed Medication

If your child needs to take prescribed medication during school hours, you are required to fill out form 525-13 - Authorization to Administer Prescribed Medication and turn it in to our health room technician at the beginning of the school year. Please take note of the following: 

• Parents/guardians fill out Part I

• Your child’s health care provider should fill out Part II. 

• Medication labels should be in English and match the instructions written in the form.

• Medications must be new and unopened. 

• Students cannot self-administer medication and cannot be in possession of them for safety reasons.  

If you need this form in another language, click here. 

Emergency Care for the Management of a Student with a Diagnosis of Anaphylaxis

 The authorized prescriber prescribed Epinephrine Auto Injector WILL NOT BE ADMINISTERED IN SCHOOL OR DURING SCHOOL sponsored activities without a parent/guardian signed authorization and waiver and an authorized prescriber's order/authorization for students with a known diagnosis of anaphylaxis. Please be sure to turn in this form to our health room technician if needed. Parents/guardians fill out Part I, and your child’s health care provider should fill out Part II. 

Form: 525-24 - Emergency Care for the Management of a Student with a Diagnosis of Anaphylaxis
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Authorization to Provide Medically Prescribed Treatment

This form is to be used in consultation with the School Community Health Nurse (SCHN) for treatments such as: urinary catheterization, tracheostomy, gastrostomy feedings, and oral suctioning. These are only illustrations of typical treatments and not an all inclusive listing. Consult with our school nurse for further informaiton.

Form 525-14 - Authorization to Provide Medically Prescribed Treatment Release and Indemnification Agreement

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For all other available health forms, please click here.