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Medication Administration Forms

Medication Administration Forms

Please refer to the following forms if your child requires medication be given at school. 

These forms should be completed by the parent or guardian as well as the private MD.

All Medication Request forms will be co-signed by the school district's medical doctor as well. 

These forms should be filled out by you AND your child's medical doctor if they require medication to be kept at and given at school. 

               Each medication requires a separate form.  

               This may include daily medications or emergency medications such as epinephrine, albuterol, etc.

               Administration of Medication Form

The “Self-Administration Form” should be filled out if your child will be administering their own medication (i.e. insulin) or keeping it on them at school (i.e. albuterol inhaler).

               Self-Administration Form

 

 

Child using inhaler