This form is to be used for all medicine brought to school that is to be kept in the office and dispensed by trained school personnel. Please note the following prior to downloading and completing the form.

  1. This authorization form must be completed for all medication dispensed by the office.
    1. The physician must fill in the top portion completely, then sign and date it before medicine can be dispensed.
    2. The bottom portion must be completed by the parent. This includes the signature and contact information after the paragraph indicating that the parent requests this medication be given during school hours.
    3. The section described in #2 covers parent permission for all oral, inhaled, instilled, or topical medications to be given at school on a routine basis (a set time every day).
    4. The section at the very bottom must be completed by the parent when the medication prescribed is oral, inhaled, topical, or instilled and is to be given on a PRN or as needed basis.
  2. Students with diabetes, severe allergies, and asthma may carry their medications and equipment with them during the school day, only if certain conditions are met and the paperwork is completed. Please talk with the school nurse if your student needs to carry his medications/equipment for these conditions only.

Medication Authorization