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FORMS

Authorization for Medication
Authorization to Carry Self & Administer Medication

NURSE AND CLINIC 
Students who become ill or injured at school should obtain a pass from their teacher to visit the nurse for an assessment. Students may visit the nurse without a pass in the morning and at lunchtime. Students are permitted to leave school grounds due to illness ONLY with the approval of the nurse. It is against school policy to call home on your own and arrange to be picked-up by someone. Students should not come to school with a temperature of 100 degrees or above. Students must be fever free for 24 hours. Students need to be assessed by parents before leaving home and medicated accordingly. Injuries occurring after school hours need to be addressed by parents and/or the family physician. Elevator passes are only given out with a doctor’s note or at nurse’s discretion.

MEDICATIONS TAKEN AT SCHOOL (It is the student’s responsibility to come to the clinic to take all medication.)

  1. No medicine prescribed by a physician shall be given to a student without written consent of the physician AND parent. (BCSC 6.0-31.)
  2. It is the responsibility of the parent/guardian or designated adult to make sure that medications are delivered safely to the nurse. IC 20-34-3-18 medication that is possessed by a school for administration during school hours or at school functions for a student may be released to: the student’s parent or an individual who is at least eighteen years of age; and designated in writing by the student’s parent to receive the medication. A school corporation may send home medication that is possessed by a school for administration during school hours or at school functions with the student if the student’s parent provides written permission for the student to receive the medication.
  3. A copy of the original prescription or a BMS physician’s permission form must be on file. All prescribed medicines must have the pharmacy label on the ORIGINAL CONTAINER. This includes all medicines, inhalers and epi-pens. The school may contact the physician if there are any questions regarding the medication ordered for the well being of the student.
  4. Medication must be administered in accordance with the physician’s prescription. The dosage cannot exceed the recommendation of the Physicians Desk Reference. Any changes to doses or time of dosage must be given to the nurse in writing and signed by the physician.
  5. ONLY antibiotics that are prescribed to be given 4 times a day will be given at lunch.
  6. Non-prescription medicines (over-the-counter) will be dispensed with parent/guardian written permission. This permission will be for the period of time specified and NEVER longer than the current school year. The note should contain: the date, name of student, name of medication, and amount given, time to be given, and the times the medication was last given. All medicines are to be delivered in a new,UNOPENED container with the student’s name on it.
  7. Self-administered medicines, such as inhalers, epi-pens and insulin, must have a physician’s order stating that your child has been instructed on how to administer the medication and that they can carry it on them. The nurse needs to know the location of inhalers (example: locker, purse or backpack). This is according to I.C. 20-8.1-5.1-7.5 and 7-22.
  8. No student is to have ANY medication on them. Cough drops and throat lozenges may be brought from home with nurse approval prior to the start of school.
  9. Unless other arrangements are made, medications left at the end of the year will be disposed of.
  10. If your child goes on field trips and/or participates in sports, they will need to be capable of administering their medications on an emergency basis. Examples would be inhalers, epi-pens and insulin. If this should be a problem the parent/guardian should be present during such events.
  11. It is the student’s responsibility to come to the clinic to take all medication.

For additional information about the BPS Health Services Department, contact Director of Health Services, Gayla Vonderheide.