Please review School Board Policy #210: Use of Medications and the information below.

    After reviewing the policy and the information below, print the permission form:

    Medication Permission Form for administration during the school day

    If your child will be carrying their inhaler or injectable epinephrine, please be sure to print both pages.

    Camp KOK Medication Form


    While it is preferred that medication is administered outside of school hours, we recognize the need at times for administration to occur during the school day. If your health care provider deems it medically necessary for your child to take medication during the day, the following procedures must be completed:

    1. Written authorization from the licensed prescriber must accompany all medications. That written authorization may come in the form of:
      • A completed North Allegheny Medication Permission form (link above) or
      • Written note on the licensed prescriber’s letterhead or prescription notepad.
    2. A parent/guardian must complete the Request for Administration of Medication in School Form 210 for medication to be taken in school.
    3. The initial dose of medication must be provided prior to request of administration at school.
    4. All medication is to be in its original labeled container.
    5. When someone other than the parent/guardian delivers medication to school:
      • Container is to be placed in a sealed envelope.
      • Medication is to be delivered to the health office upon student’s arrival at school.
      • The parent assumes all responsibility for medications sent to school.
    6. Acceptable amounts of medication to be stored at school:
      • One-week supply for acute (short-term) illness
      • Thirty-day supply for chronic (long-term) conditions
    7. Changes in medication must be accompanied by a licensed prescriber’s written statement. A faxed written statement with licensed prescriber’s signature will be accepted.
    8. In addition, for students who carry and self administer emergency medications, an order is required from a licensed prescriber indicating that it is necessary for the student to carry the medication and that the student is competent of self administration. For student in grades 6 through 12, in lieu of a licensed prescriber statement, the nurse may make a determination that the student is competent of self administration (Form #210).

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