Medicine Administration Forms

Medication Administration at School:  Required Forms

For Glucagon:

For Insulin:

For Asthma:

For Epipen/Food Allergies/Other Allergies:

For Seizures:

For Prescription Medications:

  • Authorization to Give Medication
    • Medication must be brought in its original container
    • Prescription on outside of bottle must include pharmacy label with student’s name & instructions on how to administer med

For Over-the-Counter Medications:

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