Authorization for Medication Form  

Authorization for Medication During School Hours

It may be necessary for your child to be administered medication during the school year.

Lower Dauphin's medication policy states that no prescribed medication may be administered without being specifically prescribed by a licensed physician or dentist and approved by a parent/guardian.

If possible, medication administration should be scheduled by your physician so that it may be given at home. When it is necessary for your child to receive medication during school hours, please complete the Lower Dauphin School District medication form and bring medication to your child's school. Prescribed medication must be brought to school in its original prescription bottle by the parent/guardian and given to the school nurse.

Please note that this form requires the signature of your physician. Forms will be provided for each family at the beginning of the school year. Additional forms may be obtained at your child's school office or on the attached link.

If it is not possible for the parent to deliver the medication, the parent must call the school office and notify them that the student will be bringing in the prescribed medicine. In the nurse's absence, the medication should be given to the principal or the secretary.

The school nurses may also provide a few "over the counter" medications for the comfort of your child during the school day. The use of these medications is very specifically directed by the school physician, Dr. Glen S. Bartlett. The Annual Student Information Update form lists these medications and requires your initials beside each medication which you permit to be given to your child.
 
Epinephrine (Adrenalin) is not listed and would only be used in a life threatening situation.