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New Student Enrollment: Health Guidelines: Authorization to Administer Medication

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AUTHORIZATION FORM TO ADMINISTER MEDICATION

 

PLEASE CLICK ON THE LINK AT THE BOTTOM OF THIS LETTER FOR THE AUTHORIZATION FORM

 

AUTHORIZATION FOR ADMINISTRATION OF MEDICATION

 

 

 

Dear Parent(s)/Guardian(s):

 

The purpose of this letter is to inform you about our school district’s policies and procedures for administering medicines to students.  From time to time, a committee of District 113A parents, teachers, administrators, and health office personnel meets to discuss district practices that pertain to the administration of medication and to make recommendations for changes.  Our district’s policies and procedures have been updated to reflect the recent changes in Illinois law regarding asthma and allergy medications.  These are the procedures that are in place for the 2007-2008 school year:

 

1.    The district’s “Authorization For Administration of Medication” form, signed by a physician, must be approved by the school before any medication may be administered by a district employee or self-administered by a student under the supervision of a district employee.  This includes over-the-counter medications, such as aspirin and cough medicines, as well as any other short-term or long-term prescribed drugs.  It must be stressed that no medication will be administered at school without an approved authorization form.  Phone calls or notes from parents will not suffice.  Dosage changes must be authorized by a physician via written or fax communications.

 

2.    The general authorization form must be completed for all types of medication, including asthma and allergy medication.  The second form, “Addendum:  Asthma/Allergy Medication,” must also be completed when parents request that their child self-administer asthma or allergy (epinephrine auto-injector) medication at school and/or at school events, BOTH AUTHORIZATION FORMS MUST BE COMPLETED AND SUBMITTED TO THE SCHOOL.

 

3.    The authorization form requires that the parents provide most information.  The physician’s portion of the form is clearly outlined.  A blank authorization form is attached; feel free to duplicate it as needed.  Since you will have a copy at home, the form may be taken directly to the physician to be completed when he writes the prescription.  Additional copies of the form are available in the school offices and on the district’s web site (www.sd113a.org).  A completed form must be submitted at the beginning of each school year, even for long-term medications.

 

4.    Prescription medications must display the student’s name; prescription number, medication name/dosage, administration route, and/or other directions; date, refill, and licensed prescriber’s name; pharmacy name, address, phone number, and name or initials of pharmacist.

 

5.    All medications and potentially hazardous medical supplies (e.g., lancets) must be transported to and from school by a parent or other authorized adult.  Students may not carry medications/supplies to or from school (inhalers and epinephrine auto-injectors are exempt from this restriction).  Please call the school health office to make special arrangements if you or a designee is unable to drop medications at school during office hours.

 

As always, it is our goal to provide a safe and healthy environment for all of the students in District 113A.  We believe that the policies and procedures described herein will help us to do that.  If you have any questions or concerns, please feel free to call your school’s health office.  Thank you.

 

Yours in education,

Superintendent

 

AUTHORIZATION FORM TO ADMINISTER MEDICATION - 2011

 
 

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