St. Clement of Rome School

Policy for dispensing medication at school

 

The school does not supply any medication.  If a student brings medication from home to be taken at school, the following policy will be in effect.

  1. Only medication, which has been prescribed by a physician, will be given at school.
  2. Medication must be brought to school in a container appropriately and currently labeled by the pharmacy or physician, with instructions for giving the medication. (Ask the pharmacist for a small container, with the prescription label, which can be sent to school.)
  3. A note from the parent must accompany the medication.  The suggested format and the contents of the note are to be as follows:

I give permission to authorized personnel to administer the following medication to my child:

Name: _____________________  Grade: _____________ Teacher: _________________

 

Physician who ordered medication: ____________________ Phone # _______________

 

Name of medication _______________________________________________________

 

Purpose of giving medication _______________________________________________

 

Amount to be given at school _______________________________________________

 

Time of day to be administered at school ______________________________________

 

Number of days to be administered ___________________________________________

 

Starting date _____________________________________________________________

 

Any possible side effects of medication _______________________________________

 

Drug Allergies ___________________________________________________________

 

                        Parent or Guardian’s Signature _____________________________

 

  1. All non-prescription drugs should be in original container and will be administered at school ONLY:
    1. If relabeled by the pharmacy or physician with instructions for administering the medication, OR
    2. If accompanied by a note from the physician with instructions for giving the medicine, and which signifies that the medicine is to be given at school.

 

  1. If there is any change in the dose or timing of medication, the physician must submit the change in writing.  This note may be faxed or mailed to the school.  A parent may not give permission to administer medication differently than the physician’s order.

 

St. Clement School Fax Number: 314-822-8371