MEDICATION MAY BE ADMINISTERED ONLY IF IT IS ACCOMPANIED BY:

1. The written order of your physician specifying diagnosis, medication, (possible side effects), dosage, frequency and the time element for administering this medication.
2. The written request of the parent, requesting that school personnel administer the medication as ordered.
3. The family must provide the medication in a bottle, tube or container that clearly indicates date, name of child and physician, name of medication, dosage and frequency.
4. Medication must be brought in by parent or designated adult.

K-5 Permission Form

6-12 Permission Form