AMARILLO INDEPENDENT SCHOOL DISTRICT
MEDICATION POLICY AND CONSENT FORM
All prescriptions and non-prescription medications must be kept in the health room and registered with the health services staff. Medication will be administered by the school nurse, health clerk, or other staff members who are designated by the school principal.
Guidelines for taking prescription and over-the-counter medications are as follows:
- Prescription drugs must be in their original pharmacy container and properly labeled from a registered pharmacist licensed to practice in the state of Texas with the student’s name, current date, dose to be given, time to be given, and medication route to be administered. A written request signed and dated by the parent must accompany the prescribed medication. If the prescription medication is to be administered longer than 15 days, an order from a Texas physician or other health care professional with authority to write prescriptions is required. The parent request must be updated and on file at the beginning of each school year or when the student is prescribed the medication. Any medication that has expired will not be given at school.
- Over-the-counter medications must be in the original container. This medication must be properly labeled, as stated above, and accompanied by a written request signed and dated by the parent. These products will not be given more than 5 days without a doctor’s order. School nurses will not administer non-FDA approved products, herbal/dietary products, medications purchased in foreign countries, or non-traditional preparations.
- Students will not be allowed to carry medications on them except for emergency medications allowed by Texas state law: an inhaler, EpiPen, or insulin. A written statement from a physician and parent/guardian allowing the student to carry and self-administer the medicine while on school property or at a school-related event is required. The physician’s order and written parent permission must be on file in the student’s medical records.
- Sample medication given to you by a physician must be accompanied by a written prescription from the licensed physician, a written parent request, and on file in the student’s medical records.
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PARENT PERMISSION FOR MEDICATION TO BE TAKEN AT SCHOOL
Student’s Name Birthday
I , give permission on (date) for my child to receive the stated medication(s) as directed by the attending physician. I also give permission for the school nurse to contact the physician if there is a question regarding the stated medication(s).
TO BE COMPLETED BY A LICENSED PHYSICIAN
Medication:
Name Dose Frequency For the Treatment of
Medication:
Name Dose Frequency For the Treatment of
Physician’s Signature: Date:
If the above medication is an inhaler, EpiPen or insulin, and the student has shown the skill level to self-administer, I hereby give permission for him/her to self-administer:
Parent’s Signature Physician’s Signature Date