MEDICATION FORMS
Medication Administration Form
Over-the-Counter Medication Administration Form
Over-the-Counter Medication Policy
Cough Drop Permission Form (Must be renewed yearly!)
*Reminder: All medication forms MUST BE:
1) completed & signed by the provider
2) signed and dated by the parent/ guardian
3)brought to the health suite by the parent with the ordered medications.
Health Inventory Form (Needed for ALL new students and should be updated with changes in health conditions.)
Lead Testing Form Maryland (Grades Pre-K, K, and 1st only)
THIS APPLIES TO STUDENTS WITH SEIZURES AND IS NOT NEEDED FOR OTHER STUDENTS.
For students with seizures, the Seizure Action Plan MUST be completed annually, along with the Medication Administration Form for any ordered medications.
Seizure Action Plan (This form is completed by the Provider and signed by the parent/ guardian.)
Seizure Action Plan Cover Page (This form is completed by the parent/ guardian.)
Medication Administration Form (This form is completed by the provider and signed by the parent.)
*Reminder: The parent is responsible to provide the medication along with the completed forms.
THIS APPLIES TO STUDENTS WITH ALLERGY AND ANAPHYLAXIS CONCERNS AND IS NOT NEEDED FOR OTHER STUDENTS.
For students with severe allergies only, this form should be completed annually, along with the medication form if medications such as Epi-Pens or Benadryl are ordered. Both forms are completed by the provider and signed by the parent.
FARE Allergy & Anaphylaxis Form
Medication Administration Form
*Reminder: The parent is responsible to provide the medication along with the completed forms.
THIS APPLIES TO STUDENTS WITH ASTHMA AND IS NOT NEEDED FOR OTHER STUDENTS.
For students with asthma, the following form should be completed annually, along with the medication form
if an inhaler is ordered. Both forms are completed by the provider and signed by the parent.
Medication Administration Form
*Reminder: The parent is responsible to provide the medication along with the completed forms.
Consent for Communication with Third Party and Release of Records
(This is needed for the school to be able to send information to your child's provider.)
Hearing & Vision Screening Consent Form
(This will be sent out annually to applicable students and does not need to be completed until sent out.)
