Authorization for the Administration of Medication in School Form
Community High School District 99 acknowledges that the responsibility for administering medication to a student rests primarily with the student's parent or guardian. Medication will be administered by district personnel during the school day only when absolutely necessary for the health and well-being of the student. The initial dose of the medication must be given at home.
If medication is necessary, it must be brought to the school in the original container labeled by the pharmacist (or manufacturer of over the counter medications). All medications, including over the counter medications, must be accompanied by the district's medication authorization form completed and signed by both the parent and the physician; each medication must be on a separate form. Medication authorization forms are available in Health Services, Room A106. It is important to note that students are prohibited from carrying medications or keeping medications in their lockers. Only students authorized to self-administer asthma medication or rescue epinephrine are permitted to carry medications on their person.
District 99 medication authorization forms must be renewed: at the beginning of each school year, if the medication or dosage is changed, or if asked to do so by the school nurse. Empty medication containers will be sent home with the student for refill as needed and at the end of the term of medication administration. Arrangements may be made for medications to be picked up by the parent. If the parent or guardian does not pick up the medication by the end of the school year, the medication will be discarded.
Medication authorization forms are available in Health Services. Questions or concerns regarding the above policies may be directed to Health Services of South High School (630-795-8528).
Action Plan Forms
- Asthma Action Plan Form: To be completed for students with Asthma. To be accompanied by the
- Authorization for the Administration of Medication Form (e.g. inhaler).
- Food Allergy Action Plan Form: To be completed for students with severe food allergies. To be accompanied by Authorization for the Administration of Medication Form (e.g. EpiPen).
- Seizure Action Plan Form: To be completed for students with a seizure disorder. To be accompanied by
- Authorization for the Administration of Medication Form, if emergency medication prescribed (e.g. Diastat).
- Diabetes Medical Management Plan: This plan should be completed by the student's personal diabetes health care team. To be accompanied by Authorization for the Administration of Medication Form (e.g. Insulin, Glucagon).