High School Permission for Over The Counter Medications
High School Grade Levels Only
by Kellie Bamford
October 23, 2006
|
ANDOVER PUBLIC SCHOOLS USD 385
DEPARTMENT OF HEALTH SERVICES
PERMISSION FORM FOR USE OF
OVER-THE-COUNTER MEDICATIONS IN
THE HIGH SCHOOL SETTING
Name of Student: __________________________ Grade: __________ Date: ____________________
Medication Allergies: _______________________________________________________________
Current Medications: ________________________________________________________________
Parents/Guardians of Andover High School students may choose to allow their child to receive over-the-counter medications in the school setting.All medications must be presented in the original container and labeled for student use. If a change in type of drug or dosage is warranted, a new form is to be completed by the parent/guardian and presented to the Health Office. Medication will be maintained in the nurse’s office and dispensed according to label instructions and at the discretion of the Registered Nurse. If it is necessary for the student to retain possession of the medication, this must be discussed with the Registered Nurse, and requested in writing by your child’s physician.
CONSENT TO ADMINISTER OVER-THE-COUNTER MEDICATION
IN THE SCHOOL SETTING
I understand that the Registered Nurse employed by USD 385 must have written parent/guardian consent before any medication can be administered at school. I hereby certify that, my child, ____________________________ has previously had at least one dose of the medication(s) available in the School Health Office. I understand that any school employee who administers this medication to my child, will do so in accordance with USD 385 Board of Education Policy and the Practice Act of the Kansas State Board of Nursing, and shall not be liable for damages as a result of an adverse drug reaction suffered by the student. I hereby give permission for my child to be administered the following over-the-counter medications during this school year:
________Acetaminophen-Generic Tylenol
________Ibuprophen-Generic Advil
________Non-prescription medications (such as pain relievers, antacids, cold or allergy preparations, etc.) that are provided by parents and accompanied by a written request or listed below for the current school year:
1.
2.
3.
ALL PRESCRIPTION MEDICATIONS REQUIRE THE WRITTEN PERMISSION OF THE PARENT/GUARDIAN AND PHYSICIAN FOR ADMINISTRATION IN THE SCHOOL SETTING.
(Please use Prescription Medication Administration Form) All controlled substances defined as such under state or federal law will be kept in locked cabinets under the supervision of the Registered Nurse. Students who retain controlled substances on their person on school grounds are subject to the disciplinary policies of USD #385.
Signature of Parent/Guardian: ____________________________ Date______________________
