Yearly Consent to Treat and Medical Emergency Information Forms
These two forms are essential to keeping your student safe and healthy during the school day. Students will only be seen in the school nurse clinic if the Consent to Treat is signed by a parent or guardian. All students will be treated in case of an emergency. The Medical Emergency Information form will give the most up to date medical information to your school nurse.
Medication Administration at School
If it becomes necessary for a student to take medication or receive treatment during the school day, the parent or guardian must complete a request to administer medication form and file it in the school nurse’s office. If the medication or treatment is physician-prescribed, the parent or guardian must submit a written prescription from the child’s physician or the current pharmacy label with the request. Nursing staff can only follow the instructions on the prescription label. A physician’s order is also necessary for prescription samples that may have been released to the student, or for any over-the-counter medication that is not recommended for children under age twelve.
All other over-the-counter medication must be in the original container labeled with the student’s name and date of birth. Label instructions will be followed for all over-the-counter medicine unless otherwise prescribed by a physician.
Request to Administer Medication Form
A student may possess and self-administer emergency medication for a chronic disease or medical condition ONLY if the parent or guardian annually files a request for student to possess and self administer medication form with the school nurse clinic. This form must be signed by the parent or guardian and a physician or nurse practitioner.
Request to Possess and Self Administer Medication
Emergency Action Plans for Chronic Illnesses
If you have indicated your student has a chronic illness on the Medical Emergency Information form, please have one of the following action plans filled out by your physician and return to your school nurse clinic.
Asthma Action Plan
Life Threatening Food Allergy
Food Allergy Action Plan
Allergy Parent Student Guidelines
Life Threatening Environmental Allergy
Anaphylaxis Action Plan
Seizures and Epilepsy
Seizure Action Plan
Diabetes Action Plan
Sickle Cell Anemia Plan
Sickle Cell Anemia Action Plan