Health Office – Medication Forms

Our school physician writes standing orders for Tylenol and cough drops. As a parent, you can give
permission on the yellow emergency card, for your child to have either of these medications administered
at school.

Medications prescribed by a physician must be kept in the nurse’s office. These medications must be kept
in the original container and be accompanied by written permission and directions from the physician, in
order to be administered by the school nurse. There are NO exceptions to this rule. Controlled
substances need to be brought to the nurse’s office by a parent. The number of pills being brought into
school will be counted by both the parent and nurse for verification.


Children can have allergies to environmental sources, stinging insects, food and medications. If your
child ‘s physician has prescribed a medication (s) for your child ‘s allergies, there are forms that need to be
completed by the physician and parent so the medication can be given to your child in school.
Allergy Action Plan
Bee Sting Allergy Action Plan
Parent Allergy Questionnaire


The Asthma Treatment Plan is required by NJ State Law for any child who has an inhaler or nebulizer
medications in school. It needs to be completed by the_child ‘s physician and signed by the
parent/guardian. The information in the Asthma Treatment Plan enables us to assist your child should
there be a respiratory emergency during school hours.
Asthma Treatment Plan

If your child suffers from seizures it is important for the school nurse to know the history of the seizures:
triggers. Your physician will provide you with a seizure action plan for school.
Questionnaire for Parent of Student with Seizure
Seizure Action Plan