Authorization to Administer Prescription and
*All medication requires a physician's order and this SKSD authorization form.
*All prescription medication must come in the original prescription-labeled containers with the student's name, date of birth, and prescription orders that match the written order.
*Medications in the school setting are only administered by a Registered Nurse.
*If any student were to self-carry any medication, prescription or non-prescription, a physician order is required specifying this.
SKSD Emergency Health Care Plan
for Bee Stings and/or a Severe Food Allergy
*This form must be filled out and signed by a physician for any student with a bee sting and/or a severe food allergy.
*Please take note of the bottom of this document where it requests if the student is authorized to self-medicate themselves during an off-site school-sponsored activity.
*Please communicate with the school nurse if the emergency medication will be self carried by the student (This also requires a physician order).
State of RI School Physical Form
*A (third) health examination is required upon entry to the twelfth (12th) grade. This health examination must be performed after the student turns sixteen (16) years of age, and no later than six (6) months after the student enters the twelfth (12th) grade.
Asthma Action Plan
*This form will act as a physician's order to manage your student's asthma diagnosis. It must be filled out and signed by a physician annually in order for it to be valid in your student's health record.
*Please note the check boxes at the top of the page regarding authorizing student's to self carry and self administer their inhalers*
After Illness Return Attestation Form
If your student was deemed as a close contact of a positive Covid-19 case and had to quarantine, or is exhibiting signs and/or symptoms of Covid-19, you will be required to fill out, sign, and return this form upon your student's return to school along with their Covid-19 results.
Covid-19 RIDOH Playbook
*Version 5.0- Last Updated August 18, 2021