Parent Health Services Forms


Health Services Forms



There may be times throughout the year when you may need our school nurse to dispense medications to your child/children.  In those cases, we must have complete documentation and authorization to do so.

Click on the links below to download and complete the forms necessary for our school nurse to administer non-prescription or prescription medications.  Without this documentation and authorization, our nurse will not be permitted to dispense the medications to your child.  A note from the parent for all non-prescription medications will suffice as long as the medication is clearly labeled with the exact dosage to be given.  Also, all over the counter medications MUST be provided in the original container with the dosage instruction on the original label, clearly legible.

All prescription medications MUST be prescribed by a licensed health care provider and appropriately labeled in the original container by the pharmacy or health care provider.  The Physician's Statement for Administration of Prescription Medication must also be completed by a health care provider and parent/guardian when container labels on non-prescription medications do not specify dosage instructions appropriate for the child's age.


Parent's Statement for Administration of NON-PRESCRIPTION Medication 


Physician's Statement for Administration of PRESCRIPTION Medication