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Medication Forms

Forms Needed for the School Year

Please complete the forms that are needed for your child. Completed forms should be returned to the Health Office or placed in the nurse’s mailbox when the nurse is not in the building in a sealed envelope. Please keep a copy for your home records. See links below to download forms. 

  • If your child requires an over-the-counter or prescription medication during school hours to be given in school by the nurse, you will need: Permission for Administration of Medication in School Form (completed by physician and parent)
  • If your child has Allergies (food, insects, latex, etc.),that requires emergency medication in school, you will need: Allergy Health Care Plan (completed by physician and parent)
  • If your child has Asthma that requires emergency medication in school , you will need: Asthma Treatment Plan (completed by physician and parent) and  Permission for Administration of Medication in School Form (completed by physician and parent)
  • If your child has Diabetes, you will need: Diabetes Medical Management Plan (completed by physician and parent) and  Permission for Administration of Medication in School Form (completed by physician and parent)
  • If your child has Seizure Disorder, you will need: Seizure Action Plan (completed by physician) and Administration of Medication in School Form (completed by physician and parent) and Seizure Questionnaire for Parents (completed by parent)

Remember, Parents (not students) must bring in the medication(s) to the health office.

Only students, in Grades 6-8,  who have physician and parent permission, may only carry life saving medication(s); Asthma Inhaler, Epinephrine Auto Injector and/or single dose of Antihistamine (Benadryl).

If you should have any questions, please call the Health Office at 609-395-1700 ext 239 or send an email to [email protected].

Thank you,

Jillison Brophy, RN, CSN

8/28/19

 
 
 
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