Students Requiring Medication at School

Please complete the Medication Administration Authorization form for any medication to be administered for your student in the school setting.

A new Medication Authorization form must be completed for each medication and each time there is a change in dosage/instructions.

Non-prescription medication must be in the original container with the factory label and must not expire during the school year. For Non-prescription medications, please complete the top two sections of the Medication Administration Authorization form. Non-prescription medications will be stored and administered by school staff in the office.

Prescription medication must be in the original container with a pharmacy label. Prescription medications require BOTH the physician and parent authorization sections of the Medication Administration Authorization form to be completed.

ALL medication must be delivered to the office by a parent/guardian. Medication cannot be sent to school with a student.

No medication is to be carried by a student UNLESS both the physician and parent provide authorization for self-carry/administration for the following emergency medications only: epinephrine, asthma inhalers. Please complete the first and last sections of the Medication Administration Authorization form to authorize Self-Administration.

Medication Administration Authorization Form