Medication Consent Form
Dear Parent/Guardian,
This is to inform you of the Medication Administration Policy of Rutherford County Schools. If your student must have medication of any type given during school hours, you may come to school and give the medication to your student at the appropriate time.
If you choose to have designated school personnel administer your student’s medication, these guidelines must be followed:
- Parental Consent: The student’s parent/guardian must make a signed, written request that authorizes school personnel to administer the medication to the student.
- Medication Authorization/Order: A health care practitioner must prescribe the medication for use by the student and provide explicit written instructions for administering the medication.
- Certification of Necessity: The student’s healthcare practitioner must certify that administration of the medication to the student during the school day is necessary to maintain and support the student’s continued presence in school.
- Proper Container/Labeling: If the medication to be administered is available by prescription only, the parent must provide the medication in a pharmacy-labeled container with the child’s name, the name of the medication, the exact dose to be given, the time/frequency the medication is to be given, the route of administration, the number of doses in the container, and the expiration date of the medication. If the medication is available over-the-counter, it must be provided in the original container or packaging, labeled with the student’s name.
- Proper Administration: The employee must administer the medication pursuant to the healthcare practitioner’s written instructions provided to the school by the student’s parent, and in accordance with professional standards.
School personnel will not administer medications to students without the Consent Form (see attached) or receiving the medications in an appropriate pharmacy-labeled container. In fairness to those giving the medications and to protect the safety of your child, there will be no exception to the policy.
If you have any questions about the policy or other issues related to the administration of medications, please contact the School Nurse or Principal.
Thank you,
Jill Cogdill, BSN, RN, NCSN-School Nurse