507.2 - Administration of Medication to Students
507.2 - Administration of Medication to StudentsThe board is committed to the inclusion of all students in the education program and recognizes that some students may need prescription and nonprescription medication to participate in their educational program.
Medication shall be administered when the student's parent or guardian (hereafter "parent") provides a signed and dated written statement requesting medication administration and the medication is in the original, labeled container, either as dispensed or in the manufacturer's container.
When administration of the medication requires ongoing professional health judgment, an individual health plan shall be developed by an authorized practitioner with the student and the student's parent. Students who have demonstrated competence in administering their own medications may self-administer their medication. A written statement by the student's parent shall be on file requesting co-administration of medication, when competence has been demonstrated. By law, students with asthma, airway constricting diseases, respiratory distress or students at risk of anaphylaxis who use epinephrine auto-injectors may self-administer their medication upon the written approval of the student’s parents and prescribing licensed health care professional regardless of competency.
Persons administering medication shall include authorized practitioners, such as licensed registered nurses and physician, and persons to whom authorized practitioners have delegated the administration of medication (who have successfully completed a medication administration course). A medication administration course and periodic update shall be conducted by a registered nurse or licensed pharmacist, and a record of course completion shall be maintained by the school.
A written medication administration record shall be on file including:
• date;
• student’s name;
• prescriber or person authorizing administration;
• medication;
• medication dosage;
• administration time;
• administration method;
• signature and title of the person administering medication; and
• any unusual circumstances, actions, or omissions.
Medication shall be stored in a secured area unless an alternate provision is documented. Emergency protocols for medication-related reactions shall be posted. Medication information shall be confidential information as provided by law
Disposal of unused, discontinued/recalled, or expired medication shall be in compliance with federal and state law. Prior to disposal school personnel shall make a reasonable attempt to return medication by providing written notification that expired, discontinued, or unused medications needs to be picked up. If medication is not picked up by the date specified, disposal shall be in accordance with the disposal procedures for the specific category of medication.
Legal Reference:
Disposing on Behalf of Ultimate Users, 79 Fed. Reg. 53520, 53546 (Sept. 9, 2014).
Iowa Code §§124.101(1); 147.107; 152.1; 155A.4(2); 280.16; 280.23.
281 IAC §41.404(3)
657 IAC §8.32(124); §8.32(155A).
655 IAC §6.2(152).
Date of Adoption:
August 11, 1975
Date of Review:
August 8, 2022
August 14, 2023
507.2E1 - Authorization - Asthma or Airway Constriction Medication Self-Administration Consent Form
507.2E1 - Authorization - Asthma or Airway Constriction Medication Self-Administration Consent Form_________________________________ ___/___/___ _________________ ___/___/___
Student's Name (Last), (First) (Middle) Birthday School Date
The following must occur for a student to self-administer asthma or other airway constricting disease medication or for a student with a risk of anaphylaxis to self-administer an epinephrine auto-injector:
- Parent/guardian provides signed, dated authorization for student medication self-administration.
- Parent/guardian provides a written statement from the student’s licensed health care professional (A person licensed under chapter 148 to practice medicine and surgery or osteopathic medicine and surgery, an advanced registered nurse practitioner licensed under chapter 152 or 152E and registered with the board of nursing, or a physician assistant licensed to practice under the supervision of a physician as authorized in chapters 147 and 148C) containing the following:
- Name and purpose of the medication,
- Prescribed dosage, and
- Times or special circumstances under which the medication or epinephrine auto-injector is to be administered.
- The medication is in the original, labeled container as dispensed or the manufacturer's labeled container containing the student name, name of the medication, directions for use, and date.
- Authorization shall be renewed annually. In addition, if any changes occur in the medication, dosage or time of administration, the parent is to notify school officials immediately. The authorization shall be reviewed as soon as practical.
Provided the above requirements are fulfilled, the school shall permit the self-administration of medication by a student with asthma or other airway constricting disease or the use of an epinephrine auto-injector by a student with a risk of anaphylaxis while in school, at school-sponsored activities, under the supervision of school personnel, and before or after normal school activities, such as while in before-school or after-school care on school-operated property. If the student abuses the self-administration policy, the ability to self-administer may be withdrawn by the school or discipline may be imposed, after notification is provided to the student’s parent.
Pursuant to state law, the school district or and its employees are to incur no liability, except for gross negligence, as a result of any injury arising from self-administration of medication or use of an epinephrine auto-injector by the student. The parent or guardian of the student shall sign a statement acknowledging that the school district is to incur no liability, except for gross negligence, as a result of self-administration of medication or an epinephrine auto-injector by the student as provided by law.
Medication Dosage Route Time
Purpose of Medication & Administration /Instructions
/ /
Special Circumstances Discontinue/Re-Evaluate/Follow-up Date
/ /
Prescriber’s Signature Date
Prescriber’s Address Emergency Phone
- I request the above named student possess and self-administer asthma or other airway constricting disease medication(s) at school and in school activities according to the authorization and instructions.
- I understand the school district and its employees acting reasonably and in good faith shall incur no liability for any improper use of medication or for supervising, monitoring, or interfering with a student's self-administration of medication
- I agree to coordinate and work with school personnel and notify them when questions arise or relevant conditions change.
- I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment.
- I agree the information is shared with school personnel in accordance with the Family Education Rights and Privacy Act (FERPA).
- I agree to provide the school with back-up medication approved in this form.
- Student maintains self-administration record.
/ /
Parent/Guardian Signature Date
(agreed to above statement)
Parent/Guardian Address Home Phone
Business Phone
Self-Administration Authorization Additional Information
Reviewed: August 14, 2023
507.2E2 - Parental Authorization and Release Form for the Administration of Prescription Medication to Students
507.2E2 - Parental Authorization and Release Form for the Administration of Prescription Medication to Students_________________________________ ___/___/___ _________________ ___/___/___
Student's Name (Last), (First), (Middle) Birthday School Date
School medications and health services are administered following these guidelines:
- Parent has provided a signed, dated authorization to administer medication and/or provide the health service.
- The medication is in the original, labeled container as dispensed or the manufacturer's labeled container.
- The medication label contains the student’s name, name of the medication, directions for use, and date.
- Authorization is renewed annually and immediately when the parent notifies the school that changes are necessary.
Medication/Health Care Dosage Route Time at School
Administration instructions
Special Directives, Signs to Observe and Side Effects
/ /
Discontinue/Re-Evaluate/Follow-up Date
/ /
Prescriber’s Signature Date
Prescriber's Address Emergency Phone
I request the above named student carry medication at school and school activities, according to the prescription, instructions, and a written record kept. Special considerations are noted above. The information is confidential except as provided to the Family Education Rights and Privacy Act (FERPA). I agree to coordinate and work with school personnel and prescriber when questions arise. I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment.
/ /
Parent's Signature Date
Parent's Address Home Phone
Additional Information Business Phone
Authorization Form
Reviewed: August 14, 2023
507.2E3 Administration of Medication to Students-Parental Authorization and Release form for Independent Self Carry and Administration of Prescribed Medication for Independent Delivery of Health Services by Student
507.2E3 Administration of Medication to Students-Parental Authorization and Release form for Independent Self Carry and Administration of Prescribed Medication for Independent Delivery of Health Services by StudentPARENTAL AUTHORIZATION AND RELEASE FORM FOR INDEPENDENT SELF CARRY AND
ADMINISTRATION OF PRESCRIBED MEDICATION O
R
INDEPENDENT DELIVERY OF HEALTH
SERVICES BY THE STUDENT
____________________________________/___/___
____________________/___/___
Student's Name (Last), (First), (Middle)
Birthday
School
Date
I request the above named student (Parent/Guardian initial all that apply)
______ Carry and complete coadministration of prescribed medication, when competency has been demonstrated to licensed health personnel working under the auspices of the school. In accordance with applicable laws, students with asthma, airway constricting diseases, respiratory distress or students at risk of anaphylaxis who use epinephrine auto -injectors may self-administer their medication upon the written approval of the student’s parents and prescribing licensed health care professional regardless of competency. The information provided by the parent for medication administration is confidential as provided by the Family Education Rights and Privacy Act (FERPA) and any other applicable laws. I agree to provide safe delivery of the medication to and from school and to pick up remaining medication at the end of the school year or when medication is expired. If the students abuses the self -administration policy, the ability to self-administer may be withdrawn by the school or discipline may be imposed, after notification is provided to the student’s parent.
______________________________________________________________________________________
Prescribed Medication Dosage Route Time at School
______ Co-administer, participate in planning, management and implementation of special health services at school and school activities after demonstration of proficiency to licensed health personnel working under the auspices of the school.The information provided by the parent for health service delivery is confidential as provide by the Family Education Rights and Privacy Act (FERPA) and any other applicable laws. I agree to coordinate and work with school personnel and the prescriber (if indicated) when questions arise. I agree to provide safe delivery of the student’s equipment necessary for health service delivery to and from school and to pick up remaining equipment at the end of the school year.
Special Health Services Delivery:
__________________________________
Procedures for abandoned medication disposal shall be inaccordance with applicable laws.
Prescriber’s Signature:____________________________________
Date:__________________________________________________
and credentials (when indicated for health service delivery)
Parent/Guardian Signature:________________________________
Date:__________________________________________________
Parent/Guardian address:__________________________________
Home phone:___________________________________________
Adopted: August 14, 2023
Reviewed:
Revised: