Medication at School
Medication Administration Permission Form
If your child needs to take medication daily or occasionally during the school year, please have your doctor complete this form. All medication administration, including over the counter medication requires this form to be completed by your child’s doctor. The form must also be signed by a parent. Medication must be brought to the nurse by a parent. All medication should be in the original pharmacy container. No morning or late day medication will be given. Only medications required for life threatening emergencies will be given on a field trip. Your doctor may suggest that asthma inhaler and Epipens be carried by students in their backpacks for immediate use when needed, please speak with your nurse if that is the case.
Print the Medication Administration Permission Form
Allergy Medication Administration Permission Form
If your child is prescribed an epinephrine auto-injector for allergy, please have your doctor complete this form. Your doctor may also complete the portion of this form for self-administration of both the epinephrine and an antihistamine if he/she feels your child is able to self-administer. This form must also be signed by a parent.
Forms:
Print the Food Allergy & Anaphylaxis Emergency Care Plan
Asthma Action Plan
If your child has a history of asthma, uses an inhaler or a nebulizer, please have your physician complete the asthma action plan. Your doctor should also complete the self-administration portion of this form if he/she feels your child is able to self-administer the medication.
Forms:
Print the PACNJ Asthma Treatment Plan
Seizure Action Plan
If your child has a history of epilepsy or seizures, uses rescue medications for seizures, please have your physician complete the seizure action plan.
Forms:
Print the Seizure Action Plan
HIPPA Privacy Authorization Form
Authorization for Use or Disclosure of Protected Health Information.