Boles
ISD School Health Services
Phone:
903-883-2161 x207
Fax: 903-883-4531
Administration
of Medication at School
Requests
for the administration of medications by school personnel may be as follows:
1.
When
such medication cannot be given outside of the school day.
2.
Prescription
medications require a physician’s request to continue to be taken at school
when the medication needs to be taken beyond a 10-day period of time. (May not
take more than 3 consecutive days unless evidence of medical care.)
(FFAC-Local)
3.
Medication
must be in the original container properly labeled by the pharmacist filling
the prescription, or labeled by the manufacturing Drug Company if the
medication is available over the counter. (OTC label to include indications,
dosage and warnings/contraindications)
(Texas Education Code 21.914)
4.
The
School Health Office must have a parent authorization on file before school
personnel may assist with administration of medications.
Medically untrained
personnel will administer medications at those times when the Nurse is
unavailable.
*See back of form for Inhaled medication permission.
Additional
directions: (time of day, any special requirements in regard to food, interval
between doses etc.) _________________________________________________________________________
Precautions, side effects, and unfavorable reactions:
_____________________________________
Additional
directions: (time of day, any special requirements in regard to food, interval
between doses etc.) _________________________________________________________________________
Precautions, side effects, and unfavorable reactions: ______________________________________
______________________________
Telephone _____________ FAX ________________
(Printed
name of Physician)
Physician’s Signature: ___________________________________________________________
(Office stamp is not sufficient – please sign
Doctor’s/PA’s/NP’s legal signature)
Parents/Guardians: Please
completes this part of the form or provide separate parent/guardian
authorization note. Thank You
I,
the parent/guardian of _________________________________ request the above medication be administered to the
above named student. The Nurse may find
it necessary to contact your child's health care provider for
information/clarification of a medication order or the condition requiring
medication. Your signature below will give the nurse permission to request
information.
I do hearby give my consent for the release and exchange
of information contained in the medical record of my child (named above).
(Home)
(Work/other)