Medication Guidelines & Forms

The following are various forms needed for students with Chronic Conditions, Injuries and Medication Administration. Please read all policies and procedures.

Every document must be completely filled out. Missing information will delay our ability to assist your student. Please make sure to have physician's signature, parent signature and the school nurse must sign all request and action plans. Please make sure the Medication Administration Times are indicated correctly, so that the staff will have ample time to administer.

For Non-prescription medications, please provide an unopened bottle. Students are not allowed to bring in medications, parent or guardian must bring medications.

Here are the most common forms below.

If you need additional information, here is the Round Rock ISD Health Services website: https://roundrockisd.org/health-services/

• Request to Administer Medication Form and Policy - English

• Medication Policy - Spanish

• Anaphylaxis/Allergy Form for Epipen- English

• Anaphylaxis/Allergy Form for Epipen-Spanish

• Self-Carry/Self-Administration Form

• Special Procedure Form

• Asthma Action Plan

• Seizure Action Plan