ContractAdministration of Medication Agreement • March 30th, 2016
Los Alamos Public Schools “We prepare confident, life-long learners.” Administration of Medication at School Agreement for Self-Administrationof Inhaler Medication Date: ____________________ School: ______________________________________ Student ID Number Last First MI Birth Date / / Gender Male FemaleGrade: Home Room Teacher Drug Allergies Parent/Guardian: Last First Relationship Home Phone # Cell Phone # Work Phone # My child’s physician has completed a medication permission form indicating that he/she my self –administer a Metered Dose Inhaler (MDI) to treat an asthmatic condition. This form is currently on file in the school nurses office. I give permission for my child, , to carry this MDIto school and to school activities in order to use this medication in an event of an asthma episode. My child has been instructed in the proper use of the MDI and has demonstrated that he/she has the ability to properly administer this medication. ________________________________________ also
Administration of MedicationAdministration of Medication Agreement • September 13th, 2016
Many pupils will need to take medication in school at times. In most cases the administration of medication will be short-term. Other pupils have medical conditions such as asthma or diabetes that if not properly managed could limit their access to education and the administration of medication in these circumstances is likely to be long term. Some children have conditions that also require emergency treatment and plans e.g. severe allergic conditions (anaphylaxis) or epilepsy. Pupils with such conditions are regarded as having health care needs and may require some support or reasonable adjustments to be fully included in the life of the school.
ContractAdministration of Medication Agreement • March 30th, 2016
Los Alamos Public Schools “We prepare confident, life-long learners.” Administration of Medication at SchoolAgreement for Diabetes Self-Assessment and Self-Administration of Medication Date: School: Student ID Number Last First MI Birth Date / / Gender Male Female Grade: Home Room Teacher Drug Allergies Parent/Guardian: Last First Relationship Home Phone # Cell Phone # Work Phone # My child’s physician, , has prescribed diabeticmedication, provided instruction to my child in the correct and responsible use of the medication, and approved my child’s ability to perform self-assessment and medication self- administration of the appropriate medication. The physician’s medical orders and treatment plan are currently on file in the school nurse’s office.I give permission for my child, , to self managehis/her diabetes as noted in the physician’s medical orders and his/her school health planMy child has been instructed in the self-assessment of his/her diabetes needs and has demonstrated th
Administration of Medication to Pupils Agreement between Parents and School (Appendix 1)Administration of Medication Agreement • January 4th, 2021
In order to keep the administration of medication to a minimum, the Head or Medication Coordinator should consider requesting that parents administer the daily doses out of school hours. However, if this is not possible it will be necessary for the school and parents to make a formal agreement to enable members of staff to administer medication to pupils during the school day by completing the form below.
