Name of student __________________________________ School____________________________________Grade_________________________ Medication _______________________________Dosage ___________________________ Purpose of medication______________________________________________________ ________________________________________________________________________ Time of day medication is to be given ______________________ Possible side effects ________________________________________________________ ________________________________________________________________________ Anticipated number of days it needs to be given at school ______________ Date __________ Signature of health care practitioner ______________________________ It is understood that the medication is administered solely at the request of and as an accommodation to the undersigned parent or guardian. In consideration of the acceptance of the request to perform this service by the school nurse or other designee employed by the Miami Yoder School District, the undersigned parent or guardian …
Read Full Policy- Last Reviewed/Revised:
- Last Adopted: December 9, 2010