Valley View South Elementary

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Nurse's Office » Medical Authorization Forms

Medical Authorization Forms

IMPORTANT FORMS


A.) Asthma - Inhaler Authorization and Action Plan

If your child has asthma and requires an inhaler, please print out the asthma authorization form and take it to your child's physician. Please ask the physician to fill out the form to give your child's nurse additional instructions in the event your child needs assistance.

B.) IILNESS

Only medications that are required to enable a student to stay in school should be given at school. Medication to be given 3 times a day should be given before school, after school, and at bedtime unless a particular time is specifically noted by physician.

All medication should be in the original container and labeled with your child's name.

Please print medication authorization form (for more than one medication print out separate forms), fill it out, and bring it with the medication to the clinic.

For non-prescription medications that is over the counter that you would like for us to give your child .

Please bring us the medication and please print and sign the non-prescription form below in the attachment.


C.) Severe Allergy

If your child suffers from severe allergies that requires medication in the event of a reaction, please print out the authorization form and fill out completely by you and your child's physician.

If you and your child's physician want the child to carry their EpiPen, then specific notation should be made by the physician to authorize this.

PLEASE RETURN ALLERGY FORM TO SCHOOL NURSE

D.) Special Diet

If your child needs a special diet please print out the special diet form and take it to your child's physician. Please ask the physician to fill out the diet plan to give your child's nurse additional instructions in the event your child needs assistance.

Form documents are found at the bottom as Files attachments