Code No. 507.2R1 Administration of Medication to Students Regulation

No over-the-counter medication shall be administered at school, unless the school has the parent/guardian's permission. 

Prescription medication will be dispersed to students during a school day only if the following requirements are met:

  1. Medication must be in the original container, from the pharmacy with the directions clearly stated.  This serves two purposes: signifies permission from the doctor and includes directions from the pharmacist.  Pharmacists will supply another labeled container for school upon request when the prescription is filled.  NO BAGGIES OR ENVELOPES WILL BE ACCEPTED AT SCHOOL.  It is the parent’s responsibility to ensure that the medication is current and that all information regarding the medication is current.
  2. Parents/guardians must give written authorization for the administration of the medication.  It is the parent’s responsibility to ensure that the information provided to the district, including, but not limited to the written authorization, is current.

Students are to bring all medications to the school office immediately upon their arrival at school.Students are not to carry over-the-counter medications with them during the school day unless approved by the school nurse.Students are not to carry prescription medication with them during the school day unless ordered by the physician and cleared by the school nurse.

Medication on school premises shall be kept in a locked container in a limited access storage space.Only appropriate personnel shall have access to the locked container.Each school or facility shall designate in writing the specific locked and limited access space within each building to store pupil medication.More specifically, the following requirements shall be followed:

  1. In each building in which a full-time registered nurse is assigned, access to medication locked in a designated space shall be under the authority of the nurse.
  2. In each building in which a less than full-time registered nurse is assigned, access to the medication shall be under the authority of the principal.

Iowa law requires school districts to allow students with asthma or other airway constricting diseases to carry and self-administer their medication as long as the parents and prescribing physician report and approve in writing.  Students do not have to prove competency to the school district.

Emergency protocols for medication-related reactions shall be posted.

A written medication administration record shall be on file, including:

  • date;
  • student's name;
  • prescriber or person authorizing administration;
  • medication;
  • medication dosage;
  • administration time;
  • administration method;
  • signature and title of the person administering medication; and
  • any unusual circumstances, actions, or omissions.

Medication information shall be confidential information and shall be available to school personnel with parental authorization.

The superintendent/designee shall be responsible, in conjunction with the school nurse, to develop rules and regulations governing the administration of medication, prescription and non-prescription, to students.  Students and parents/guardians shall be provided with the requirements for medication procedures by the school annually.

 

Revised/Reviewed: February 25, 2019

Code No. 507.2E1 Parental Authorization and Release Form for the Administration of Medication to Students

Code No. 507.2E1
 
PARENTAL AUTHORIZATION AND RELEASE FORM FOR THE
ADMINISTRATION OF MEDICATION TO STUDENTS
 
The undersigned(s) are the parent(s), guardian(s), or person(s) in charge of _______________________________ (student’s full legal name), who is in the ______ grade at the ____________________ building in the Interstate 35 Community School District.
 
It is necessary that the above student receive the following medication(s), at the following frequencies, for the following time period (Attach additional sheets if necessary):
 
(a) ______________________________________________________________________
(Medication)
                                    ____________________________________________________
            (Frequency (i.e., once at noon, etc.))
 
            Beginning on _________________ and continuing through ________________.
            (Duration)
 
I hereby request the Interstate 35 Community School District, or its authorized representative, to administer the above-named medication to my child named above and agree to:
1.         Submit this request to the principal or school nurse;
2.         Personally ensure that the medication is received by the principal or school nurse administering it in the container in which it was dispensed by the prescribing physician or licensed pharmacist or is in the manufacturer's container;
3.         Personally ensure that the container in which the medication is dispensed is marked with the medication name, dosage, interval dosage, and date after which no administration should be given. OR
I hereby authorize my child to self-administer his/her medication as he/she has shown the competency to do so.  I hereby agree to:
1.         Submit this request to the principal or school nurse;
2.         Personally ensure that
a.         the medication is received by the principal or school nurse administering it in the container in which it was dispensed by the prescribing physician or licensed pharmacist or is in the manufacturer's container, or
b.         the medication will be kept in the student's possession but only with prior written permission from the parent and principal.
3.         Personally ensure that the container in which the medication is dispensed is marked with the medication name, dosage, interval dosage, and date after which no administration should be given.
___________________________________  _________________
(Signature of Parent/Guardian)            (Date)
___________________________________  _________________
(Printed Name of Parent/Guardian)      (Phone Number)                     
 
Revised:  June 29, 2015                                                              

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Code No. 507.2E2 Parental Authorization and Release Form for the Self-Administration of Asthma Medication to Students

I authorize my child, _________________________, to self-administer his/her own asthma inhaler or airway medication at school. I understand that the Interstate 35 Community School District and its employees are to incur no liability, except for gross negligence, as a result of any injury arising from my child's self-administration of medication. The school district, and its employees, acting reasonably and in good faith, shall incur no liability for any improper use of medication, or for supervising, monitoring, or interfering with a student's self-administration of medication.

______________________________________________________________________

Parent or Guardian Signature                                                                              Date

----------------------------------------------------------------------------------------------------------

The Following to Be Completed by the Student’s Physician:

I have prescribed the following medication (asthma inhaler/airway medication)

______________________________for this student____________________________

Name of Medication                                                                           Students Name

In this dosage:_________________________________________________________.

Dosage and Instructions (Frequency of Use)

For the purpose of:______________________________________________________.

________________________________________________           ________________.

Doctor's Signature                                                                                          Date

 

Revised/Reviewed: February 25, 2019

Code No. 507.3E3 Parental Authorization and Release Form for the Self-Administration of Epinephrine VIA EPI-PEN

Parental Authorization and Release Form for the Self-Administration of Epinephrine via EPI

 

I authorize my child, _________________________, to carry an epi-pen auto-injector and to self-administer his/her own epinephrine at school in the event of an emergency following my child’s:

•           Demonstration of his/her knowledge and understanding of anaphylaxis and correct usage of the epi-pen to the school nurse;

•           Agreement never to share the epi-pen with another student; and

•           Agreement to obtain or send for assistance from the school nurse or another adult immediately in the event of an allergic reaction and/or use of the epi-pen.

______________________________________________________________________

Parent or Guardian Signature                                                                              Date

The Following to Be Completed by the Student’s Physician:

I have prescribed an epi-pen auto-injector in the following dosage _____________________ to _______________________for his/her allergy/allergies to the following (list all applicable allergies):____________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

I have further instructed him/her with respect to:

•           The events surrounding the need for epinephrine;

•           The consequences of incorrectly administering epinephrine;

•           The signs and symptoms of an allergic reaction; and

•           The correct usage of an epi-pen.

 

________________________________________________           ________________.

Doctor's Signature                                                                              Date