Parents must obtain written authorization from a doctor for any medication (over-the-counter or prescription) to be administered during school hours. The Medication Administration Form can be obtained from the school nurse or printed from below. It is necessary for the parent to also sign the form to give permission to the nurse to administer the medication. Medications must be supplied to the nurse in their original container and be brought to the nurse by a parent or guardian. A separate form must be completed for each medication. See below for medication forms relating to Epinephrine Pens (Epi Pens), Asthma, and Diabetes.
Medication Administration FormAn Asthma Treatment Plan form must be completed by a physician and also signed by a parent for any student requiring inhaler or nebulizer medications; even if the student will be carrying his/her own inhaler.Any student with severe life-threatening allergies who has a prescription for an Epinephrine Pen (Epi-Pen) must have a physician complete the Food Allergy and Anaphylaxis Emergency Care Plan as well as Medication Administration Form for each medication; If a student is permitted by his doctor to self administer his/her own Epinephrine Pen, please have physician indicate same on the Emergency Care Plan. Forms can be found on the Middle School Virtual Backpack or by clicking the link below. Please make sure ALL forms are completed and signed.A student with Diabetes must have an Individual Health Care Plan/Medicaiton Administration and Emergency Plan for Diabetes for Current School Year completed by the student's physician and parent. Also a page with your child's own Personal Symptoms of Hypoglycemia and Hyperglycemia. Also attached is a list of supplies needed. I have also included the Emergency Plan for a Diabetic Student for the Current School Year for Bus Drivers as per Chapter 40 of Tittle 18A of the New Jersey Statutes. I will discuss this with your student's bus driver and have the bus driver sign.Individual Health Care Plan/Medication Administration and Emergency Plan for Diabetes for Current School YearEmergency Plan for a Diabetic Student for the Current School Year for Bus Drivers as per Chapter 40 of Title 18A NJ Statutes