ADMINISTRATION OF MEDICATTON IN SCHOOL In accordance with the New Hampshire State Board of Education and local school board policy, when necessary for a child to take medication during the school day, the following information is required for the child's safety and must be provided to the school nurse prior to administration of medication.
1.
2. 3.
Medication in the original container, delivered to the school by the parent/guardian. Authorization to Administer the medication signed by the parent/guardian. A written medication order by the prescribing health eare provider.
MEDICATION ORDER
** This section to be completed by the prescribing health care provider ** Child's Name: Medication, Dose, Route, Time(s): Medication, Dose, Route, Time(s): Duration of administration: Condition for which child is taking this medication: Special Instructions: If this medication is an inhaler or injectable, is this child capable and responsible to canJ, and administer his or her own medication in the school setting or do you recommend supervision by the school nurse at this
lime? Signature of prescribing health care provider:
Date:
PLEASE PRINT Provider's Name: Address and Phone Number:
AUTHORIZATION TO ADN/ilNISTER MEDICATION
** This
section to be completed by the parenVguardian *+ request the school nurse, principal, or person
(Parent/Guardian)
designated by the principal, administer the above medication to: (Student Name)
I will not hold the Merrimack Valley School District, school nurse, principal, or members of the school staff that assist my child with his/her medication. Communication between the child's health care provider and the school nurse is essential to safe and effective administration of medication at school. give consent for such communication to occur as needed. Si
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Assume responsibility for safe delivery of the medication in its original container to the. school. ⢠Have a ... Page 1 of 1. Non-Prescription Medication Form.pdf.
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Have my healthcare provider complete a new medicine form for my child if the medicine or dose changes. I agree for child's healthcare provider to talk with the ...
I release Jefferson County School District staff from all liability for any injury caused by the administration of the medication in compliance with medication label.
Page 1 of 32. Arcadia Unified School District. Student Health Services. 150 S. Third Avenue, Arcadia, CA 91006. Telephone: (626) 821-1731 ... Fax: (626) 821- ...
containing ephedrine or pseudo-ephedrine will be allowed. Students may NOT share their ... Medication Procedure.pdf. Medication Procedure.pdf. Open. Extract.
Medication includes both prescription and non-prescription medication and includes those taken ... Stop Date: ... Displaying Medication Authorization Form.pdf.
Page 1 of 1. Grand Blanc Community Schools. Medication Authorization Form. Permission Form for Administration of Medication at School. Medication includes both prescription and non-prescription medication and includes those taken by mouth, taken by.
incur no liability whatsoever as a result of any untoward reaction arising from the administration of medicine to my. child. I hereby indemnify and hold harmless ...
Page 1 of 3. 3/22/2016 Medication Health Fraud > Public Notification: ZlimXter Capsules contain hidden drug ingredient ... FDA laboratory ... (http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/UCM349464.pdf), then.
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Page 1 of 1. MEDICATION POLICY. 1. Prescription medications should be given at home in the mornings so that your student is comfortable and ready to start. the school day. Most prescription meds are given 2- 3 times a day, at home before school, and