Medication Authorization Form

The Alabama State Department of Education and the Alabama Board of Nursing have provided these guidelines.  Before a medication can be given, the school must have a completed SCHOOL MEDICATION PRESCRIBER /PARENT AUTHORIZATION signed by the prescriber and parent/guardian.  If the medication order is changed (such as a change in the dosage), an additional form is necessary.  For prescription medications, a pharmacy-labeled container is required with the student’s name, prescriber’s name, name of medication, strength, dosage, time interval, route and date of drug’s discontinuation when applicable.  If a medication will need to be given at school for two weeks or longer, the parent/guardian should request two containers from the pharmacist with one labeled for school use.  When the medication to be provided is a nonprescription medication, an original container of the drug identifying the medication and the entire manufacturer’s labeling plus the student’s name (written legible on the container) should be supplied by the parent/guardian.  The parent must indicate under which specific conditions/complaints that this nonprescription or over the counter medication (OTC) should be provided.  A form is needed for each medication to be given at school.

 

Some students may need to self-administer their medication such as insulin injections and inhalers.  The bottom part of the form should be signed if the student is able to consume, inject, instill, or apply prescription medication in the manner directed by the licensed prescriber without additional assistance or direction.

 

The first dose of a new medication or change in dosage (increase or decrease) of current medication should be given at home with the exception of emergency medication such as EpiPen injections.

 

Students must not deliver controlled substances to the school due to the potential for abuse.  An adult should deliver these medications to the school.  It is recommended that no more than a six-week, school day supply of the prescribed medication be stored at school.  When the course of medication is completed, out of date, or at the end of the school year, the parent/guardian shall be advised to pick up any unused portions of medication.

 

These guidelines are put in place for the safety of the students.  Questions should be directed to the school nurse.

 

Arab Primary School 256-586-6005

 

Arab Elementary School 256-586-6085

 

Arab Junior High School 256-586-6074

 

Arab High School 256-586-6026