Medication Policy & Forms
A parent or guardian of the student must submit a form for any medication to be given during the school day. The following consent forms can be provided by the school or may be printed off and brought to the school.

For Prescribed Medication: Permission for School Administration of Prescription Medication

For Over-The-Counter Medications like Tylenol and Motrin: Permission for School Administration of Non-Prescription Medication

Physicians need to sign Authorization Forms and Emergency Action Plans

For ONLY Asthma:

Asthma Inhalers Authorization Form

Asthma Emergency Action Plan

Asthma IHP Questionnaire

For ONLY Anaphylaxis:

Anaphylaxis Autoinjectors Authorization Form

Anaphylaxis Emergency Action Plan

Anaphylaxis IHP Questionnaire

For BOTH Asthma & Anaphylaxis:

Asthma Inhalers Authorization Form

Anaphylaxis Autoinjectors Authorization Form

Allergy/Anaphylaxis Emergency Action Plan

Allergy/Anaphylaxis IHP Questionnaire

For ADD/ADHD:

Permission for School Administration of Prescription Medication

ADD/ADHD IHP Questionnaire

For Diabetes Type 1:

Please have a Physician complete a Diabetes Medical Management Plan also known as a DMMP.

Diabetes Type 1 IHP Questionnaire

For Seizures:

Seizures Emergency Action Plan

Seizures IHP Questionnaire

All medication must be in a container appropriately labeled by the pharmacy, healthcare provider, or in the original container. The child's health care provider’s request and consent must contain the following information:

name of medication
dose to be given
time to be given
number of days to be administered
any special instructions
ICD-10 code

All medication will be stored in a locked cabinet in the health room. Medications must be picked up at the end of the year or it will be properly disposed of.

Self-managed medications will be evaluated on an individual basis by the school nurse. A written physician's order is required, as well as parental consent.

The school nurse is responsible for ensuring that:

the administration of medication is properly documented
that therapeutic benefits and side effects are monitored
that appropriate information is communicated to parents, healthcare providers, and school staff

Medications will be sent on field trips. The teacher will be responsible for transportation, securing, administration and documentation of medication on field trips. No over-the-counter medications containing aspirin may be given as needed. This includes, but is not limited to, Pepto-Bismol, Alka-Seltzer, Triaminic.

Lead Academy does not provide over-the-counter medications such as Motrin, Tylenol, or cough drops.

LEAD Academy