Niagara Catholic District School Board
ADMINISTRATION OF MEDICATION TO STUDENTS ADMINISTRATIVE OPERATIONAL PROCEDURES | |
300 – School/Students
| No 302.2
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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:
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