Medication Policies & Consent Forms

Parents wishing to provide permission for their  student to  carry and self-administer emergency medication should read the policy below and complete the permission request form.

The Board shall permit students  in district  schools to possess asthma inhalers  and epinephrine auto-injectors and to self-administer the prescribed  medication in compliance  with state law and Board policy.W[2]


Asthma inhaler shall mean a prescribed  device used for self-administration of short-acting, metered doses of prescribed  medication  to treat an acute asthma  attack.

Epinephrine auto-injector shall mean a prescribed  disposable drug delivery  system designed for the self-administration of epinephrine to provide  rapid first aid for persons suffering the effects of anaphylaxis.

Self-administration shall mean a student's  use of medication in accordance with a prescription or written  instructions from a licensed physician, certified  registered nurse practitioner or physician assistant.


Before a student  may possess or use an asthma inhaler  or epinephrine auto-injector in the school setting, the Board shall require  the following:

             a. Name of the drug.   

             b. Prescribed dosage.

             c. Times medication is to be taken

             d. Length of time medication is prescribed.

             e. Diagnosis or  reason  medication  is to be taken.

             f. Potential serious reaction or side effects of medication

             g. Emergency response.

             h. if  child is qualified and able to self administer.

The student  shall notify  the school nurse immediately following  each use of an asthma inhaler or epinephrine auto-injector.ill

The district reserves  the right  to require  a statement from  the licensed physician, certified registered  nurse practitioner or physician  assistant for the continued  use of a medication beyond the specified time period.

A written  request  for student  use of an asthma inhaler  and/or  epinephrine auto-injector shall be submitted annually, along with required  written statements from the parent/guardian and an updated prescription.

Student  health records shall be confidential and maintained in accordance with state and federal laws and regulations. L2.1[6]

A student  whose parent/guardian completes  the written  requirements for the student  to possess an asthma inhaler  or epinephrine auto-injector and to self-administer the prescribed medication  in the school setting  shall demonstrate to the school nurse the competency  for self-administration and responsible behavior  in use of the medication. Determination of competency  for self-administration shall be based on the student's  age, cognitive function, maturity and demonstration of responsible  behavior.

Students  shall be prohibited from sharing, giving, selling, and using an asthma inhaler  or epinephrine auto-injector in any manner  other than which it is prescribed during  school hours 1 at any time while on school property, at any school-sponsored activity, and during  the time spent traveling to and from school and school-sponsored activities. Violations  of this policy shall result in  loss of privilege to self-carry  the asthma inhaler or epinephrine auto-injector and disciplinary action in accordance with Board policy.

If the district denies a student's request to self-carry and asthma inhaler or auto-injector or the student has lost the privilege of self-carrying an asthma inhaler or auto-injector, the student' prescribed medication shall be appropriately stored at a location in close proximity to the student. The student's classroom teachers shall be informed where the medication is stored and a means to access the medication.

The district shall annually distribute to students and parents/guardians this policy along with the Code of Student Conduct.

The district shall post this policy on district website.


  1. A written request from the parent/guardian that the school complies  with the order of the licensed physician, certified  registered  nurse practitioner or physician  assistant.
  2. A written statement from the parent/guardian acknowledging that the school is not responsible for ensuring the medication is taken and relieving the district and and its employees of responsibility for the benefits or consequences of  the prescribed medication.
  3. A written statement from the physician! certified registered  nurse practitioner or physician that states:
    1. Name, address, telephone and federal DEA (Drug Enforcement Agency) number of the pharmacy.
    2. Student's name.
    3. Directions for use (dosage,frequency and time of administration,route,special instructions).
    4. Name and registration number of the licensed prescriber.
    5. Prescription serial number.
    6. Date originally filled.
    7. Name of medication and amount dispensed.
    8. Controlled substance statement,if applicable.
    9. Guidelines for disposal of contaminated needles or other contaminated sharp materials immediately in an appropriately labeled,puncture resistant container.
    10. Processes for immediately returning to parents/guardians all discontinued and outdated medications,as well as all unused medications at the end of the school year.
    11. Proper documentation of an medications returned to parents/guardians and for all medications disposed of by the Certified School Nurse or other licensed school health staff. Documentation shall include,but not be limited to,date, time,amount of medication and appropriate signatures.
    12. An order from the licensed prescriber for the medication,including a statement that it is necessary for the student to carry the medication and that the  student is capable of self-administration.
    13. Written parent/guardian consent.
    14. An Individual Health Plan including an Emergency Care Plan.
    15. The nurse shall conduct a baseline assessment of the student's health status.
    16. The student shall demonstrate administration skills to the nurse and responsible behavior.
    17. Assigning school health staff to be available.
    18. Utilizing a licensed person from the school district's substitute list.
    19. Contracting with a credible agency which provides temporary nursing services.
    20. Utilizing licensed volunteers via formal agreement  that delineates responsibilities of both the school and the individual.
    21. Addressing with parent/guardian the possibility of obtaining from the licensed prescriber a temporary order to change the time of the dose.
    22. Asking parent/guardian to accompany the child on the field trip, with proper clearances.
    23. Arranging for medications to be provided  in an original  labeled container  with only the amount  of medication needed.

ALL  parents/guardians who wish to provide permission for medication administration  during school hours or wish to provide permission for self-administration of  emergency medication should read the

SDHT Medication Administration Policy 210


 The Board shall not be responsible  for the diagnosis  and  of student  illness. The administration of prescribed  medication to a student  during  school hours in accordance with the direction of a parent/guardian and licensed prescriber  will be permitted only when failure to take such medicine  would jeopardize the health  of the student  or the student  would not be able to attend school if the medicine  were not available  during  school hours.


For purposes of this policy, medication  shall include all medicines prescribed  by a licensed prescriber  and any over-the-counter medicines.

For purposes of this policy, licensed prescribers  shall include  licensed physicians  (M.D. and D.O.), podiatrists, dentists, optometrists, certified registered  nurse practitioners and physicians assistants, consistent with state law.


The Board directs all district employees to comply with the Pennsylvania  Department of Health's  Guidelines for Pennsylvania  Schools for the Administration of Medications and Emergency Care.

Before any medication may be administered to or by any student  during  school hours, the Board shall require  the written request  of the parent/guardian, giving  permission for such administration.[1][2]

Delegation of Responsibility

The Superintendent or designee, in conjunction with the Certified  School Nurse (CSN), shall develop administrative regulations for the administration and self-administration of students' medications.

 All medications  shall be administered by the Certified  School Nurse, or in the absence of the Certified  School Nurse by other licensed school health staff (RN, LPN), except as otherwise noted in this policy.

In the event of an emergency,  a district employee  may administer  medication when s/he believes, in good faith, that a student  needs emergency  care.W

The Certified School Nurse shall collaborate with parents/guardians, district administration, faculty and staff to develop an individualized healthcare plan to best meet the needs of individual students.[4][5]

 The policy and administrative regulations for administration of medications shall be reviewed at least every two (2) years and revised as necessary.


The district shall inform all parents/guardians, students and staff about the policy and administrative  regulations governing the administration  of medications.

All standing medication orders and parental consents shall be renewed at the beginning of each school year.

Student health records shall be confidential and maintained in accordance with state and federal laws and regulations and the  Department of Health Guidelines.I.§..l[7]

 Students may  possess and use asthma inhalers and epinephrine auto-injectors when permitted in accordance with state law and Board policy.[§J.[9]PLEASE SEE POLICY 210.1

Delivery and Storage of Medications

All medication shall be brought to the  nurse's office,or the  main office if the  nurse is in another building,by the parent/ guardian or by another adult designated by the parent/ guardian. All medication shall be stored in the  original pharmacy-labeled container and kept in a locked cabinet designated for  storage of medication. Medications that require refrigeration shall be stored and locked in a refrigerator designated only for medications. The district shall not  store more than a thirty-day supply of an individual student's medication.

Medication should be recorded and logged in with the date,name of student,name of medication, amount of medication,and signatures of the parent/guardian or designated adult delivering the medication and the  school health personnel receiving the  medication.

Nonprescription medication must be delivered in its original packaging and labeled with the  student's name.

Prescription medication shall be delivered in its original packaging and labeled with:

All medication shall be accompanied by a completed Medication Administration Consent and Licensed Prescriber's Medication Order  Form,or other written communication from the  licensed prescriber.

Disposal of Medications

Procedures shall be developed for the  disposal of medications consistent with the

Department of Health Guidelines

Student Self-Administration of Emergency Medications

Prior to allowing a student to self-administer emergency medication,the district shall require the  following:[9]

The nurse shall provide periodic and ongoing assessments of the  student's   self-management skills.

The student shall notify  the school nurse immediately following  each occurrence of self-administration of medication.

Students shall demonstrate a cooperative attitude in all aspects of

self-administration of medication.  Privileges for self-administration of medication will be revoked if school policies regarding self-administration are violated.

Administration of Medication  During Field Trips and Other School-Sponsored


The Board directs planning for field trips and other school-sponsored activities to start early in the school year and to include collaboration  between administrators, teachers, nurses, appropriate parents/ guardians and other designated health officials.[lO]

Considerations  when planning for administration of medication during  field trips  and other school-sponsored programs and activities  shall be based on the student's individual needs and may include  the following:

Security procedures shall be established  for the handling  of medication during  field trips and other school-sponsored activities.