MAYSVILLE LOCAL SCHOOLS    

twitter
twitter
twitter

Clinic Forms

Medication Information

 
 
Please pay close attention to these forms. Some will need to be filled out by both the parent AND the physician.
 
Parents - In regards to your child needing to take medication at school, please read the following information:
 
Any medication, whether prescription, or over-the-counter, must be brought in by the student’s parent/guardian

 

  •  Medication to be given at school MUST:

               o Be brought in, in its original container, by the student's parent/guardian

               o Have the original pharmacy label on the container

               o Have a prescription medication administration form signed by both the doctor and the parent/guardian

 

  •  Any medication change will require:

               o A new doctor’s order

               o A new, original pharmacy container and label

               o A new prescription medication administration form signed by both the doctor and the parent/guardian

 

  • All medication is kept in a locked cabinet in the clinic.
  • Medications received by the school are tracked and logged on the student’s medication administration form.
  • Medications are counted when parents bring in new medicine and are also counted monthly.
  • Medication is tracked to make sure that the medication is not lost, stolen, or administered incorrectly.

 

 

For any questions, please call:

Erika Baker, BSN, RN

(740) 454-4490 (Maysville Elementary)

or
(740) 454-7999 (Maysville 6-12)

Printable Forms

This form is for children who will need to take medication at school that has been prescribed by their physician. The form must be filled out and signed by both the parent and the physician.
This form is for children who will need to take over-the-counter medication at school. This includes medication such as Tylenol, Motrin, Ibuprofen. The form must be filled out and signed by the parent.
This form is for children who have an inhaler prescribed for them to help with asthma symptoms. This form authorizes the school to possess and use an inhaler. This form must be signed by both the parent and the physician.
This is a form that needs to be filled out by parents of students who have asthma that may require use of an inhaler. This form does not serve as permission to give the inhaler, but rather as information for school staff to have on hand regarding your child's condition and possible reaction. This form is to be filled out and signed by the parent.
This form is for children who have been prescribed an epi pen and will need to keep it at school. This form is for authorization and use of an epi pen. It must be signed by both the parent and the physician.
This is a form that needs to be filled out by parents of students who have a severe allergy that may require use of an Epi-pen. This form does not serve as permission to give the Epi-pen, but rather as information for school staff to have on hand regarding your child's allergy and possible reaction. This form is to be filled out and signed by the parent.
This is a form that needs to be filled out by parents of students who have a seizure condition. This form serves as information for school staff to have on hand regarding your child's seizure condition. This form is to be filled out and signed by the parent.
View text-based website