Forms

Administration of Medication by School Personnel
A medication permission form must be completed and on file in the school nurse prior to administration at school. See page 20 of the student handbook.

Medication form- link to: (see attachment below-"administration of medication form")
1. Students who self-carry medication
Ohio state laws (ORC 3313.716 and 3313.718) permit students to self-carry asthma inhalers and epinephrine medication at school. Parents should consider the following guidelines when making the decision to allow the child to self-carry an inhaler or EpiPen:

Student factors:

* Desire to carry and self-administer
* Appropriate age, maturity, or developmental level
* Ability to identify signs and symptoms of asthma and/or anaphylaxis
* Knowledge of proper medication use in response to signs/symptoms
* Ability to use correct technique in administering medication
* Knowledge about medication side effects and what to report

*Willingness to comply with school's rules about use of medicine at school, for example:
1.	Keeping one's bronchodilator inhaler and/or auto-injectable epinephrine with him/her at all times;
2.	Notifying a responsible adult (e.g., teacher, nurse, coach, playground assistant) during the day when a bronchodilator inhaler is used and immediately when auto-injectable epinephrine is used;
3.	Not sharing medication with other students or leaving it unattended;
4.	Not using bronchodilator inhaler or auto-injectable epinephrine for any other use than what is intended;
5.	Responsible carrying and self-administering medicine at school in the past (e.g. while attending a previous school or during an after-school program).

NOTE: Although past asthma history is not a sure predictor of future asthma episodes, those children with a history of asthma symptoms and episodes might benefit the most from carrying and self-administering emergency medications at school. It may be useful to consider the following.

* Frequency and location of past sudden onsets
* Presence of triggers at school
* Frequency of past hospitalizations or emergency department visits due to asthma

Parent/guardian factors:

* Desire for the student to self-carry and self-administer
* Awareness of school medication policies and parental responsibilities
* Commitment to making sure the student has the needed medication with them, medications are refilled when needed, back-up medications are provided to the school office, and medication use at school is monitored through collaborative effort between the parent/guardian and the school nurse

Self-carry forms: * A student contract and a medication form MUST be on file in the school nurse office at the beginning of each school year.

Epipen Self-Carry Medication form (attachment below)

EpiPen Student/parent self-carry contract (attachment below)

Asthma inhaler Medication form (attachment below-"Administration of medication form")

Asthma inhaler Student/parent self-carry contract (attachment below)

Medical Forms	School Forms
Epi-Pen Self Carry Medication Form	Field Trip Form
Epi-Pen Student/Parent Self Carry Contract Form	Field Trip Form
Student Form for Self Carry/Administration of Inhalers	Internet Acceptable Use Policy
Administration of Medication Form