Medication Forms

Medication should be given at home if at all possible. When, under exceptional circumstances, a student is required to take medication, it must be in compliance with these guidelines.

1. The parent or guardian must provide written consent for a member of the school staff to dispense medication via “Parental Authorization for Medication” form. These forms can be obtained below.

2. Prescription medications will only be administered under the direction of a physician. This is done by the physician or practitioner completing and signing the “Authorization for Medication” form, available below. The parent or guardian must facilitate the completion and signing of the form by the physician.

3. Medication must be received in the original container from the pharmacy and it must be labeled with the following:
A. Name of Student
B. Name of Medication
C. Dosage of Medication
D. Time the Medication is to be dispensed
E. Name of the prescribing physician
F. Name of the pharmacy

4. Appropriate records shall be maintained and periodic instruction will be documented by the completion of a medication administration form.

5. Medication will be stored in a designated container in each building. Any unused medication will be returned to the parent.

The Northland Pines School District reserves the right to refuse any request to dispense medication.

Parent/Guardian Prescription & Non-Prescription (Over the Counter) Medication Request

Parents, when bringing in over the counter medications for your children to be administered during the school day, please fill out the proper form (Non-prescription (over the counter) Medication Request form) available from your school office. The medication shall be in the original, unopened manufacturer’s package/container. It must list in a legible format the ingredients and recommended therapeutic dose.