Physical Examination form for Sports

Medication Request form

Required Immunizations by Grade Level

In accordance with RCW 28A.210.260 and 28A.210.270, Nine Mile Falls School District is authorized to administer ORAL medication to students during school hours. It is our policy that such medications will only be administered when the failure to receive the medication may result in the student being unable to attend school and/or well enough to participate in learning activities. We define medication to mean all drugs - whether prescription or over-the-counter. Medications must be brought to the school office by the parent/guardian and will be stored in a locked cabinet. Prescription medication will be counted and signed in by the parent/guardian and a school employee.

1. Prescription Medication

1. All medication must have physicians or licensed health care provider’s written orders.
2. All medication must have parent/guardian/custodian signed permission
3. All medication must be in the original prescription bottle (container) and properly labeled with student’s name, name of drug, dosage, and name of physician/dentist/health care provider, date and time of day to be given.
4. If a tablet is to be divided (cut in half) the parent, prior to the time it is brought to school, must do this.
5. Sample medication given by the physician or licensed health care provider must also be properly labeled and in the original container or package.
6. Inhalers - The physician/ licensed health care provider and parent must state in writing on the "Authorization" form, if the student is to carry an inhaler. The school shall not be responsible for documentation of medication carried and self-administered by the student. The school will not be responsible for assuring that the medication will be self-administered by the student.

2. Non-Prescription Medication

1. Non-prescription medication (i.e. cough drops, vitamins, aspirin, cough syrup or any over-the-counter medication) will not be given by school staff without written physician’s or licensed health care provider’s orders plus signed parent/guardian/custodian permission.
2. Non-prescription medicine must be in the original container and must be labeled with the student’s name, name of physician/dentist/licensed health care provider, dosage, and time of day to be given.

3. Non-Oral Medication

1. School personnel will not administer eye drops, ear drops, ointments, topical medication or injections. These medications must be self-administered by the child or the parent guardian/custodian or adult designee may come to school and administer the medication (Exception: Injectables in life-threatening situations.)

If medication is self administered, indicate so on the Medication Request Form.

4. Administering Medication
   1. The parent/guardian/custodian must fill out and sign the parent portion of the Medication Request Form.
   2. The physician/dentist/licensed health care provider must write a request for medication to be administered at school.  This request may be on a prescription blank.
   3. Written, current and unexpired further instructions must be obtained from the physician/dentist/licensed health care provider regarding the administration of prescribed medication to students for more than 15 days.
   4. This authorization is good for the current school year only. (Rev. 4/03 )12/97