Asthma - Inhaler Authorization and Action Plan
your child has asthma and requires an inhaler, please print out the
asthma authorization form and take it to your child's physician. Please
ask the physician to fill out the action plan to give your child's
nurse additional instructions in the event your child needs assistance.
If you would
like your child to carry their inhaler with them, his/her physician must
sign the authorization form granting this permission. We encourage an
additional inhaler be provided to stay in the clinic.
Medication Authorization Form
Only medications that are
required to enable a student to stay in school should be given at
school. Medication to be given 3 times a day should be given before
school, after school, and at bedtime unless a particular time is
specifically noted by physician.
All medication should be in the
original container and labeled with your child's name. Please limit
over-the-counter medication to be stored in the clinic to small
Please print medication
authorization form (for more than one medication print out separate
forms), fill it out, and bring it with the medication to the clinic.
Severe Allergy - Medication Authorization and Action Plan
your child suffers from severe allergies that requires medication in
the event of a reaction, please print out the authorization form to be
filled out completely by you and your child's physician.
you and your child's physician want the child to carry their EpiPen,
then specific notation should be made by the physician to authorize