ADMINISTRATION OF MEDICATION TO STUDENTS ADMINISTRATIVE OPERATIONAL PROCEDURES | |
300 – School/Students
| No 302.2
|
Adopted Date: October 27, 1998
| Latest Reviewed/Revised Date: February 3, 2025
|
| Adopted Date:
Revision History: | October 27, 1998
May 26, 2009 December 20, 2016 December 17, 2020 February 3, 2025 |
NIAGARA CATHOLIC DISTRICT SCHOOL BOARD
ADMINISTRATION OF PRESCRIBED AND NON-PRESCRIBED MEDICATION DURING SCHOOL HOURS |
| A.TO BE COMPLETED BY PARENT/GUARDIAN | |
| Student’s Name: | School: Grade: |
| Date of Birth: | OEN: |
| Parent/Guardian Name: | Day Phone: Cell: |
| Parent/Guardian Name: | Day Phone: Cell: |
| Emergency Contact: | Phone: Relationship: |
| Parent/Guardian Approval:
I hereby request and give permission to _____________________________________________School to administer the noted medication according to Board Procedures and the instructions of the Physician/Medical Professional.
| |
| Signature of Parent/Guardian: Date: | |
| B.TO BE COMPLETED BY PHYSICIAN/MEDICAL PROFESSIONAL
This is to advise that I have prescribed the administration of the following medication which must be taken during school hours. | Name of Medication: | Dosage and Instructions Per Administration:
| Diagnosis/Reason for Medication:
| |||
| Possible Side effects:
| Administration Parametres (Dates):
From:_______________________ To:____________________________ | Time(s) of day for administration:
| ||||
| Physician/Medical Professional Name, Address and Phone:
| Signature: | |||||
NIAGARA CATHOLIC DISTRICT SCHOOL BOARD
RECORD OF ADMINISTRATION OF PRESCRIBED AND NON-PRESCRIBED MEDICATION |
| Name of Student
| OEN# | School Name |
| DATE | TIME | DOSAGE | SIGNATURE | ||||
| Copy Pro v ided to Parent / Guardian : |
· yes | · no | Date: | ||||
| Remaining M e di ca tion Return e d : |
· to parent | · to local pharmacy | Date: | Signature of Principal: Date:
| |||