Medicine Administration Forms

Medication Administration at School:  Required Forms

For Diabetic Care:

For Asthma:

  • Asthma Action Plan
    • MUST BE SIGNED BY HEALTHCARE PROVIDER
  • Administration of Medication Form
    • ​​​​​​​NOTE:  If inhaler is to remain with the student, "YES" must be checked in the area which discusses "may carry or self-administer"
    • MUST BE SIGNED BY HEALTHCARE PROVIDER
    • Inhaler must be in box with label attached as received from the pharmacy

For Allergies:

For ALL Allergies:

For FOOD Allegeries:

Other Allergies:

For Seizures:

For Prescription Medications:

  • Administration of Medication Form
    • ​​​​​​​MUST BE SIGNED BY HEALTHCARE PROVIDER
    • Medication must be brought in its original container
    • Label on the outside of the bottle must be from the pharmacy with student's name and instruction on how to administer medication.
    • Label should be legible and in English

For Over-the-Counter Medications:

Other Health needs or concerns (tracheostomy, g-tube feeding, oxygen, catheters) – Contact your School Nurse ASAP