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    Medication Form - English

    Medication Authorization Form
    Self Administration Form - English

    Self-Carry Administration Form

    Food Allergy & Anaphylaxis Emergency Care Plan

    Allergy and Anaphylaxis Emergency Plan

    Asthma Action Plan

    Diabetes Medical Management Plan

    Seizure Action Plan

     

     

     

     

     

     

     

     


    Authorization for Release of Records

    Release of Information Form

     


    Mobile Dental Van - English

    Athena Dental Form

    Administration of Medications - All medication is to be transported to and from school by a parent/guardian or other responsible adult. Students are not to transport or have medications in their possession. The following rules apply to the administration of medication at school:

    1. Parents/guardians have the primary responsibility for administering medications to their students. Administering medication during school hours or during school-related activities is discouraged unless it is necessary for the critical health and well-being of the student.

    2. Nothing in the policy shall prohibit any school employee from providing emergency assistance to students, including administering medication.

    3. Before any medication can be given at school a medication authorization form must be completed and signed by the prescribing physician and the parent/guardian; this includes prescription and over-the-counter medications (Tylenol, Advil, Tums, Midol, cough drops, cold medications, etc.).

    4. Prescription medications are to be in their original containers with the student’s name, medication name, dosage, physician’s name and pharmacy name listed. All prescription drugs turned into the health office must be counted by the school nurse and either the child’s parent/guardian or a school administrator. A total number of pills must be recorded. All medications shall be stored in an appropriate locked cabinet.

    5. Pursuant to the Illinois School Code, students are permitted to carry and self-administer epinephrine auto-injectors, asthma inhalers, and diabetes medication, where appropriate. The parents or guardians of the student must provide the school with:

    a. Written parent/guardian authorization for the self-administration of medication.

    b. For the use of an epinephrine auto-injector, written authorization from the student’s physician, physician assistant or advanced practice registered nurse that specifies the name and purpose of the epinephrine auto-injector, the prescribed dosage, and the time or circumstance under which the epinephrine auto-injector is to be administered.

     
    c. The prescription label, which must include the name of the medication, prescribed dosage, and the time or circumstances under which the medication is to be administered.
    d. The parents or guardians of the student must sign a statement acknowledging that the district is to incur no liability, except for willful and wanton conduct, as a result of any injury arising from the self-administration of the medication regardless of whether authorization was given by the pupil's parents or guardians or by the pupil's physician, physician's assistant, or advanced practice registered nurse and that the parents or guardians must indemnify and hold harmless the school district or nonpublic school and its employees and agents against any claims, except a claim based on willful and wanton conduct, arising out of the self-administration of medication or use of an epinephrine auto-injector regardless of whether authorization was given by the pupil's parents or guardians or by the pupil's physician, physician's assistant, or advanced practice registered nurse. It is strongly encouraged that parents provide a back-up inhaler or epi-pen to be kept in the health office. The information provided will be kept on file in the nurse’s office.

    6. All medication forms (prescription, over-the-counter and self-administration) must be renewed at the beginning of each school year with a doctor and parent/guardian signature.

    7. Students will not be allowed to leave campus to obtain medication unless given Administrative approval.

    8. Short-term antibiotics are often prescribed by physicians to be administered three (3) times a day. Please check with the prescribing physician; often he/she wants these doses to be spread out over the longest time period possible while the student is awake. These medications can be given in the morning before school, after school and at bedtime. Often giving antibiotics at lunch results in the doses being administered too close together.

    9. The parent/guardian is responsible for picking up extra medication at the end of a treatment and/or school year. Medicine left at the end of the school year will be discarded.