507.04 - Administration of Medication to Students

507.04 - Administration of Medication to Students

Some students may need prescription and nonprescription medication to participate in their educational program.  These students shall receive medication concomitant with their educational program.  When administration of the medication requires ongoing professional health judgment, an individual health plan shall be developed by the licensed health personnel with the student and the student’s parent.

Medication, including over-the-counter medication, shall be administered only when the student’s parent or guardian (hereinafter “parent”) provides a signed and dated written statement requesting medication administration and the medication is in the original container which is labeled by the pharmacy or the manufacturer with the name of the child, name of the medication, the time of the day which it is to be given, the dosage, and the duration.  Written authorization will also be secured when the parent requests student co-administration of medication when competency is demonstrated.  It is the parent’s responsibility to ensure that the medication is current; that all information regarding the medication is current; and that the information provided to the district, including, but not limited to the written authorization, is current.

Students who have demonstrated competence in administering their own medications may self-administer their medication as long as all other relevant portions of this policy have been complied with by the student and the student’s parent or guardian.  A written statement by the student’s parent shall be on file requesting co-administration of medication, when competence has been demonstrated.  By law, students with asthma or other airway constricting diseases may self-administer their medication upon approval of their parents and prescribing physician regardless of competency.

Persons administering medication shall include a parent, the physician, the licensed registered nurse (school nurse), and persons who have successfully completed a medication administration course.  A medication administration course and periodic update shall be conducted by a registered nurse or licensed pharmacist, and a record of course completion kept on file at the school district.

A written medication administration record shall be on file including:

  • date;
  • student’s name;
  • prescriber or person authorizing administration;
  • medication;
  • medication dosage;
  • administration time;
  • administration method;
  • signature and title of the person administering medication; and
  • any unusual circumstances, actions, or omissions.

Medication shall be stored in a secured area unless an alternate provision is documented.  The school nurse, or in the nurse’s absence, the nurse’s designee shall have access to the medication which will be kept in a secure area.  Students may carry medication only with the approval of the parents and building principal of the student’s attendance center.  By law, students with asthma or other airway constricting diseases may self-administer their medication upon written approval of their parents and prescribing physician regardless of competency. Students do not have to prove competency to the school district.  Emergency protocols for medication-related reactions shall be posted.  Medication information shall be confidential information.

 

 

 (January 17, 2005; March 21, 2011; January 19, 2015; August 19, 2019)

 

dawn@iowaschoo… Fri, 05/29/2020 - 14:54

507.04 E1 - Asthma or Airway Constricting Medication Self- Administration Consent and Authorization Form

507.04 E1 - Asthma or Airway Constricting Medication Self- Administration Consent and Authorization Form

________________________________    __________   _______________   ____/____/____
Student’s Name (Last), (First), (Middle)       Birthday              School                     Date

In order for a student to self-administer medication for asthma or any airway constricting disease:

  • Parent/guardian provides signed, dated authorization for student medication self-administration.
  • Physician (person licensed under chapter 148, 150, or 150A, physician, physician’s assistant, advanced registered nurse practitioner, or other person licensed or registered to distribute or dispense a prescription drug or device in the course of professional practice in Iowa in accordance with section 147.107, or a person licensed by another state in a health field in which, under Iowa law, licensees in this state may legally prescribe drugs) provides written authorization containing:
    • purpose of the medication,
    • prescribed dosage,
    • times, or;
    • special circumstances under which the medication is to be administered.
       
  • The medication is in the original, labeled container as dispensed or the manufacturer’s labeled container containing the student name, name of the medication, directions for use, and date.
  • Authorization is renewed annually.  If any changes occur in the medication, dosage or time of administration, the parent is to notify school officials immediately.  The authorization shall be reviewed as soon as practical.

Provided the above requirements are fulfilled, a student with asthma or other airway constricting disease may possess and use the student’s medication while in school, at school-sponsored activities, under the supervision of school personnel, and before or after normal school activities, such as while in before-school or after-school care on school operated property.  If the student abuses the self-administration policy, the ability to self-administer may be withdrawn by the school or discipline may be imposed.

Pursuant to state law, the school district or accredited nonpublic school and its employees are to incur no liability, except for gross negligence, as a result of any injury arising from self-administration of medication by the student.  The parent or guardian of the student shall sign a statement acknowledging that the school district or nonpublic school is to incur no liability, except for gross negligence, as a result of self-administration of medication by the student as established by Iowa law.

 

____________________        ______________        ________________    ________________

Medication                              Dosage                                    Route                          Time

 

Purpose of Medication & Administration/Instructions: __________________________________

______________________________________________________________________________

 

AUTHORIZATION – ASTHMA OR AIRWAY CONSTRICTING MEDICATION SELF-ADMINISTRATION CONSENT FORM

___________________________________              __________________________________
Special Circumstances                                                Discontinue/Re-Evaluate/Follow-up Date

 

___________________________________              _____/_____/_____
Prescriber’s Signature                                                 Date

 

___________________________________              __________________________________
Prescriber’s Address                                                  Emergency Phone

 

I request the above-named student possess and self-administer asthma or other airway constricting disease medication(s) at school and activities according to the authorization and instructions.

I understand the school district and its employees acting reasonably and in good faith shall incur no liability for any improper use of medication or for supervising, monitoring, or interfering with a student’s self-administration of medicine.

I agree to coordinate and work with school personnel and notify them when questions arise or relevant conditions change.

I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment.

I agree the information is shared with school personnel in accordance with the Family Education Rights and Privacy ACT (FERPA).

I agree to provide the school with back-up medication approved in this form.

(Student maintains self-administration record).)

 

_________________________________      _____/_____/_____
Parent/Guardian Signature                              Date                            (agreed to above statement)

 

_________________________________      ________________
Parent/Guardian Address

Home Phone _________________________

Cell/Work Phone______________________

                                                                                                                                               

                                                                                                                                               

                                                                                                                                               

Self-Administration Authorization Additional Information                           

 

 

(January 17, 2005; March 21, 2011; January 19, 2015; August 19, 2019)

 

dawn@iowaschoo… Fri, 05/29/2020 - 14:55

507.04 E2 - Parental Authorization and Release Form for the Administration of Prescription Medication to Student

507.04 E2 - Parental Authorization and Release Form for the Administration of Prescription Medication to Student

 

________________________________        ___/___/____  _________________  ___/___/___

Student’s Name (Last), (First), (Middle)        Birthday          School                         Date

 

School medications and health services are administered following these guidelines:

  • Parent has provided a signed, dated authorization to administer medication and/or provide the health service.
  • The medication is in the original, labeled container as dispensed or the manufacturer’s labeled container.
  • The medication label contains the student’s name, name of medication, directions for use, and date.
  • Authorization is renewed annually and immediately when the parent notifies the school that changes are necessary.

 

______________________    __________    ______________________    ________________

Medication/Health Care          Dosage                        Route                                      Time at School

 

 

 

____________________________________________________________________________

 

Administration instructions.

 

____________________________________________________________________________

 

____________________________________________________________________________

 

Special Directives Signs to observe and Side Effects

 

_____/_____/_____

Discontinue/Re-Evaluate/Follow-up Date

 

_________________________________      _____/_____/_____

Prescriber’s Signature                                     Date

_________________________________      ________________

Prescriber’s Address                                      Emergency Phone

 

I request the above-named student carry medication at school and school activities, according to the prescription, instructions, and written record kept.  Special considerations are noted above.  The information is confidential except as provided to the Family Education Rights and Privacy ACT (FERPA).  I agree to coordinate and work with school personnel and prescriber when questions arise.  I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment.

 

____________________________________            _____/_____/_____
Parent’s Signature                                                       Date

 

____________________________________            _______________________
Parent’s Address                                                        Home Phone

 

____________________________________            _______________________
Additional Information                                               Business Phone

___________________________________________________________________________

 

____________________________________________________________________________
Authorization Form

 

 

(January 17, 2005; March 21, 2011; January 19, 2015; August 19, 2019)

 

dawn@iowaschoo… Fri, 05/29/2020 - 14:58