Important note: All of the indicated forms should be submitted to the School Nurse in your building when the school year begins. Having forms filed in a timely manner will insure that your child received immediate and appropriate medical care, insuring a safe environment in the school setting. Forms may be mailed or hand delivered.

Administering Medication to Students

Please use the following form if your child will require medical attention to be administered by the School Nurse during the course of the school day. You must complete top of the form and your physician must complete the bottom.

Administering Medication to Students – Form 23-02

Photo Identification for Medicine Administration

Please use the following form in order that staff may be involved in administration of medication will have a photo identification of your child

Photo Identification for Medication Administration – Form 25-02

Epi-Pen in School

If you child requires an Epi-Pen in school you will need to sign for the School Nurse to administer the medication and/or appoint a delegate to administer the medication, in case the school nurse is unavailable.

Consent for Epi-Pen or Adrenalin Administration by the School Nurse –  Form 8-02

Self Administration of Medicine

   -  If your child can self-administer medication in school (e.g. Epi-Pen and inhaler), you will need to read the Self – Administration Letter. Then use Form 29 to grant consent. Your physician will complete the top section and you must complete the bottom section.

Student Self-Medication –Instructions for use of Form 29-02

The State of New Jersey has signed into law a new regulation concerning administration of medication in school. The law in part addresses self-medication by students. Our school district has adopted a policy that permits self-medication by certain students.

SELF-MEDICATION OF MEDICATION FOR LIFE-THREATENING ILLNESS

A. Parents must provide the Board of Education with a written authorization for the self-administration of medication. 

Click here for Request for Student Self Medication Form

B. Your physician must submit written certification that identifies the potentially life threatening illness and is capable of and has been instructed in the proper use of the medication. (SEE FORM-PART I)
C. Permission to self-administer one medication will not be a permission to self-administer other medication.

NOTE: ALL MEDICATION MUST BE IN ORIGINAL PRESCRIPTION CONTAINER WITH THE PHARMACY LABEL ATTACHED.

IMPORTANT: PARENTAL HAND WRITTEN NOTES ALONE CAN NO LONGER BE ACCEPTED TO ADMINISTER MEDICATION. THE NEW REGULATION REQUIRES PHYSICIAN ORDERS ALSO.

If you have any questions concerning self-medication for your child, please contact your building nurse.

Asthma Action Plan

   -   If your child has a diagnosis of Asthma and will require the administration of emergency medications in school, the listed forms must be completed. Form 10 is the Asthma Action Plan.

Asthma Action Plan

Field Trip Medication

   -  If during the school year your child attends a class trip and is taking medication, you must complete a Field Trip Medication Form indicating the medication plan for that day.

Field Trip Medication – Instructions for use of Form 20-02