If your child has a severe allergy which requires an antihistamine and/or Epipen/Twinjet, please have his or her health care provider complete an Allergy Action Plan as well as an Epipen Authorization form and a Medication Authorization form.
If your child has asthma, please have his or her health care provider complete an Asthma Action Plan and an Inhaler Authorization form.
The nurse must have the parent’s permission to dispense any over-the-counter medications during the school day. If you wish to provide medication for your child to be dispensed as needed, please complete a Medication Authorization form. If your child needs to take a prescription medication during the school day, his or her health care provider must complete and sign the Medication Authorization form. All forms require a parent’s signature.
Find the following forms here:
- Allergy Action Plan
- Antihistamine Authorization
- Asthma Action Plan
- Medication Authorization
- Inhaler Authorization
- Epipen/Twinjet Authorization
- School Health Entrance Form
- School Health Instructions Form
- Confidential Health History
- Permission for Emergency Care
If you have questions or concerns, please contact the school nurse, Erin Philippart, at firstname.lastname@example.org or by calling (703) 281-9103 ext 444.