Dental Medication Forms - St. Vincent De Paul School (Page 2 of 2) in pdf

Dental Medication Forms - St. Vincent De Paul School Page 2

Medication

All prescription medications must be brought to the school office in the original container appropriately labeled

by the pharmacy or physician. Non-prescription drugs (including items such as Tylenol, etc.) must also be sent

to the school office. A note with the following information must accompany any medication: date medication is

sent, duration of permission, child’s name, time of dosage, instructions for dosage, possible side-effects and

parent’s signature.

The school will not store medications for more than five consecutive days unless the child has a note from a

physician station the nature of the illness and the duration for which the child needs to take the medication.

Medications will be administered and documented in the school office and not in the classrooms.

Students with diagnosed diabetes, asthma, or other life-threatening conditions are allowed by state law

to carry and self-administer prescribed medications if parents have signed a form indicating that their child is

capable and they prefer he/she self-medicate.

The office should be informed of any medical condition that may affect a child’s behavior, schoolwork,

or health while at school and any side-effects that may be caused from medications. Below you will find a form

for you to print and send with your child’s medication.

Copied from 2010/2011 Handbook, page 11

Please note: medications must be in original container and current

Date mediation is sent____________________________________

Name of medication__________________________________________________

Date medication is to be given _____________________________________________________________

Child’s name___________________________________________________________________________

Time of dosage_________________________________________________________________________

Instructions for dosage ( please send measuring spoon or cups)

Possible side effects________________________________________________________

Signature of parent/guardian______________________________________________

Dental Medication Forms - St. Vincent De Paul School Page 2