27J Permission for Medication Administration at School

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Prescription medications must come in a container labeled with: child’s name, name of medicine, dosage, time medicine is to be given, date medicine is to be stopped, and licensed health care provider’s name, pharmacy name and phone number. Medication must be packaged in an original container from the pharmacy.

Over-the-Counter medication must be labeled with child’s name. Dosage on the container must match the signed health care provider authorization. Medicine must be packaged in original container.

The school center agrees to administer medication prescribed by a health care provider with prescriptive authority. It is the parent/guardian’s responsibility to provide the medication. The parent agrees to pick up expired or unused medication per school’s policy. All medication left at school will be discarded according to the most current state regulatory recommendations for safe medication disposal.

By signing this document, I give permission for my child’s health care provider to share information about the administration of this medication with the nurse or school staff delegated to administer medication:

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