HEALTH SERVICES
MEDICATION FORMS
Click on the form that you need, from the list below:
Request for Medication Administration by the School Nurse - Must be completed and signed by child's physician.
Authorization for Student to Carry and Self Administer Medications - Must be completed and signed by child's physician. Used for Epi-pens and Inhalers only.
Anaphylactic Allergy Action Plan Completed and signed by a physician. Medications ordered must be provided by the parent/guardian. Submit to school nurse.
Indemnification Form for Self Administration of Medication - Completed by parent/guardian and must be submitted with Authorization for Student to Carry and Self Administer Medications.