Self-Administration of Medication by Students Law enforcement and educators should be aware that, pursuant to N.J.S.A. 18A:40-12.3, self-administration of medication by students is permitted for specific medical conditions, including asthma, life-threatening allergies and other potentially life-threatening medical conditions. The student must be permitted to self-administer medication provided that
Self-Administration of Medication. Only Students in MHS may be allowed to carry emergency medication. In order to do so, the parent and physician must also complete the SELF-ADMINISTRATION OF MEDICATION CONTRACT in addition to this form. STUDENT GRADE TEACHER Please assist my child in taking the provided medication as indicated. The school nurse or designee has my permission to communicate with my child's physician, and may counsel with school personnel regarding the possible effects of the medication on my child. I will notify the school immediately if any change in the medication is necessary. I understand the medication will be discarded after two weeks of discontinued use. PARENT/GUARDIAN SIGNATURE DATE DAY PHONE MEDICATION DOSE TIME AM PM ONLY AS NEEDED EVERY HOURS ROUTE: ORAL INHALE EYE (X X) EAR (X X) OTHER REASON SIDE EFFECTS _ GIVE MEDICATION UNTIL: (date) OR UNTIL NOTIFIED
