School Nurse
Medical Forms
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Authorization to Administer Prescription and/or Over-the-Counter Medication
This form is for ALL prescription medications as well as Over-the-Counter medications that either exceed the recommended dosage on the label and/or need to be given more than THREE times during the school year.
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Authorization for Student Possession and/or Use of an Epinephrine Autoinjector, Asthma Inhaler, Gluc
Authorization of Epi-pen, Inhaler, and/or Glucagon. In addition, this form can also be used for those students who have Type I Diabetes and need access to their glucose meter at all times. To be completed by parent / guardian AND physician.
This document helps to determine the student's readiness to carry their inhaler based on their knowledge and understanding of Asthma symptoms and how to respond.
This form is available to families who have students with asthma. Please email the completed form to your school nurse.
Epi-pen and Inhaler Self-Carry Agreement
We are also adding the self-carry agreement form which must be completed by student, parent and school nurse when a student carries those emergency medications.
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This form is to be completed by all parents who request an immunization exemption for their child based on medical, religious or philosophical objections. Please remember that in the event of an outbreak of a particular illness that is covered by a vaccine (an outbreak may be defined as only one case), your child will be excluded from school until the outbreak has been cleared by the health department unless you decide to have your child immunized at that point.
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This form is available to families who have students with food allergies. Please email the completed form to your school nurse.
Detailed description of information for parents, staff and students in order to safeguard our children at school who have significant food allergies.
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Please complete all questions. This information is essential for the school nurse and school staff in determining your student's needs and providing a positive and supportive learning environment.
In the event that your child has a seizure at school, please complete the following care plan so that we can provide the best possible care.
Vaccines for Teens and College Students
Here is a link to an article about meningococcal meningitis, a disease that can affect college students, and the importance of vaccinating students against this disease.
Teenage Drug Use Prevention
When it comes to your child's drug use or alcohol consumption, you are the first line of defense. Consider the following:
- Set rules. Let your child know alcohol and drug use is unacceptable in your family. Enforce stated consequences when family rules are broken.
- Know where your teens are and what they will be doing during unsupervised time.
- Talk to your teen.
- Keep your teens busy, especially between 3 p.m. and 6 p.m. and into evening hours. Teens who are involved in constructive, adult-supervised activities are less likely to use drugs than other teens.
- Take time to learn the facts about marijuana, prescription drug abuse, and underage drinking. Share the information with your teen in regards to the harmful effects on young people.
- Get to know your teen's friends and parents. Make sure you know their rules and standards.
- Accept the role of a parent as your major responsibility. Children do not need you to be their friend, let others be their friend. You be the parent!
Helpful Links:
www.elks.org/Youthactivities.cfm * need new link
You will also find more information at the National Council on Alcoholism and Drug Dependence
And from Lisa Cron, our Safe and Drug-Free Schools Coordinator for Greene County, the following information is from the State of Ohio regarding their prevention effort called "StartTalking-Now."
http://starttalking.ohio.gov/Parents.aspx * need new link
Multiple national surveys point to the disturbing abuse of prescription (Rx) and over-the-counter (OTC) medicines, like OTC cough medicine, among today's teens. Four percent of teens in grades 8, 10, and 12 admit to having abused cough medicine containing dextromethorphan, or DXM, to get high in the past year. Roughly one in three high school teens say they know someone who has abused cough medicine.
http://www.nasn.org/ToolsResources/DrugsofAbuse/HometoHomeroom * need new link