As mentioned on the Medications page, you do not need to fill-out the "Request to Administer Medication" form if you and your child's physician have completed and signed the following applicable documents:
New forms/action plans must be completed each school year
Epinephrine/Allergy Emergency Plan
If your child's physician has prescribed epinephrine (EpiPen/Auvi-Q or other auto-injector) for anaphylaxis, please complete the Food Allergy & Anaphylaxis Emergency Care Plan**. Please make sure form has both parent and physician signatures.
If an antihistamine is ordered, please provide this medication with your epinephrine.
Please ask the pharmacy to put an additional label on the auto-injector container. This will allow auto-injector containers to be placed back in correct boxes in the event they become separated.
Special Diet
If your child has a food allergy or intolerance or a disability that restricts their diet, please supply the nurse with this SPECIAL MEALS REQUEST FORM (Parts A & B), completed in full and signed by a licensed physician.
Asthma Medication / Action Plan / Self-Carry
If you child's physician has prescribed rescue medicine for asthma, inhaler and nebulizer treatments can be given at school, under the following conditions are met:
Asthma Action Plan must be completed and on file in the school clinic.
Nebulizer treatments: All medications and tubing for breathing treatments must be supplied by parent. We have a nebulizer machine in clinic.
If separate from the original box, the inhaler must be properly labeled (that is, pharmacy labeled attached). Please ask the pharmacy to put an additional label on the inhaler. This will allow inhalers to be placed back in correct boxes in the event they become separated.
Self-Carry/Self-Administration--Additional Conditions: According to Texas law, a student is allowed to self-carry/self-adminster their asthma medication, under the following conditions:
The physician must sign approval that your child has been instructed, understands self-medicating, and can carry and self-administer his/her rescue inhaler.
The parent must sign either the asthma action plan or the authorization to self-carry form.
The inhaler must be properly labeled. It must either be in the original box or the inhaler itself must have a separate label applied by the pharmacy. This is a health and safety issue! PLEASE, whenever you pick up a new inhaler, get the pharmacist to apply a second label to the inhaler.
This authorization may be revoked if the student demonstrates irresponsibility with inhaler storage/handling or use.
Remember: If a student carries his/her inhaler, the school nurse cannot monitor their asthma. Be sure your student knows to see the nurse if the asthma inhaler does not provide enough relief.
Seizure Medication / Action Plan
If your student is diagnosed with seizures, whether or not they have been prescribed emergency medication, a seizure action plan needs to be on file in the school clinic. You may use the sample below from the Epilepsy Foundation or your physician may use their own. The parent must also sign the seizure action plan. Emergency medication should be available for the student and provided by the parent.
When completing the action plan, it is also advised to complete the Patient Information Sheet; this further helps staff understand how your child's seizures typically present.