507.02 Administration of Medication to Students

The 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 by licensed health personnel working under the auspice of the school with collaboration from the parent or guardian, individual’s health care provider or education team pursuant to 281.14.2(256). Students who have demonstrated competence in administering their own medications may self-administer their own 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 or other airway constricting diseases may self-administer their medication upon approval of their parents and prescribing physician regardless of competency.

Persons administering medication shall include the licensed registered nurse and persons to whom authorized practitioners have delegated the administration of medication (who have successfully completed a medication administration course). The medication administration course is completed every five years with annual procedural skills checks completed with a registered nurse or pharmacist. 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: Iowa Code 124.101(1),147.107,152.1,155A.4(2),280.16,280.23(2007)

Education [281] IAC 14.1, .2

Pharmacy [657] IAC 8.32(124,155A)

Nursing Board [655] IAC 6.2(152)

Cross Reference: 506 Student Records

507 Student Health and Well-Being

603.3 Special Education

607.2 Student Health Services

Approved 9/23/11 Reviewed 8/18/2021 Revised 8-16-23

ddvorak@northl… Wed, 02/08/2017 - 15:12

507.02E1 Record of the Administration of Prescription Medication

AUTHORIZATION ASTHMA OR OTHER AIRWAY CONSTRICTING DISEASE MEDICATION OR EPINEPHRINE

AUTO-INJECTOR SELF-ADMINISTRATION CONSENT FORM

________________________________

Student's Name (Last), (First) (Middle)

___/___/___

Birthday

_____________________________________________ ___/___/__

School Date

In accordance with applicable laws, students with asthma, airway constricting diseases, respiratory distress or students at risk of anaphylaxis who us epinephrine auto-injectors may self-administer their medication upon the written approval of the student’s parents or guardians and prescribing licensed health care professional regardless of competency. The following must occur for a student to self-administer asthma medication, bronchodilator canisters or spacers, other airway constricting disease medication or 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 the prescribed medication by a student 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.

Authorization-Asthma or Airway Constricting Medication

Self-Administration Consent Form

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) and/or an epinephrine auto-injector 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 an epinephrine auto-injector or for supervising, monitoring, or interfering with a student's self-administration of medication or use of an epinephrine auto-injector. I acknowledge that the school district is to incur no liability, except for gross negligence, as a result of self-administration of medication or use of an epinephrine auto-injector by the student.
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) and any other applicable laws.
I agree to provide the school with back-up medication approved in this form.

/ /

Parent/Guardian Signature Date

(agreed to above statement)

Parent/Guardian Address Home Phone

Business Phone

Self-Administration Authorization Additional Information

Approved 9/23/11 Reviewed 8/18/2021 Revised 8-16-23

ddvorak@northl… Wed, 02/08/2017 - 15:51

507.02E2 Parental Authorization and Release Form for the Administration of Medication or Special Health Services 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 prescribed medication and/or provide the special health services listed. Electronic signatures meet the requirement of written signatures.
The prescribed medication is in the original, labeled container as dispensed or the manufacturer's labeled container.
The prescribed medication label contains the student’s name, name of the medication, the medication dosage, time(s) to administer, route to administer and date.
Authorization is renewed annually and as soon as practical when the parent notifies the school that changes are necessary.

Medication/Health Care Dosage Route Time at School

Special Health Services and Instructions, as indicated:

Special Directives, Signs to Observe and Side Effects

/ /

Discontinue/Re-Evaluate/Follow-up Date

/ /

Prescriber’s Signature Date

**************************************************************************************************************************

/ /

Parent's Signature Date

Parent's Address Phone

Additional Information Business Phone

Approved 9/23/11 Reviewed 8/18/2021 Revised 8-16-23

ddvorak@northl… Thu, 02/09/2017 - 09:30

507.02E3 Parental Authorization and Release Form for Independent Self Carry and Administration of Prescribed Medication or 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 co-administration 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 in accordance with applicable laws.

_________________________________________ ______________________

Prescriber’s Signature Date

and credentials (when indicated for health service delivery)

__________________________________________ ______________________

Parent/Guardian Signature Date

_______________________________________ __________________________

Parent/Guardian address Home phone

ddvorak@northl… Tue, 08/29/2023 - 09:55

507.02E4 Parental Authorization and Release Form for the Administration of Voluntary School Stock of Over-the-Counter Medication to Students

________________________________ ___/___/___ _________________ ___/___/___

Student's Name (Last), (First), (Middle) Birthday School Date

The district supplies the following nonprescription, over-the-counter medications that are listed below. Generic brands may be substituted, (select all that apply:

· Acetaminophen administered per manufacturer label

· Throat Lozenges administered per manufacturer label

· Other: ____________________ administered per manufacturer label (Please Specify)

Voluntary school stock of nonprescription, over-the-counter medications are administered following these guidelines:

Parent has provided a signed, dated annual authorization to administer the nonprescription, over-the-counter medication(s) listed according to the manufacturer instructions. Electronic signature meets the requirement of written signature.

The nonprescription, over-the-counter medication is in the original, labeled container and dispensed per the manufacturing label.

All other nonprescription, over-the-counter medication not listed will require a written parent authorization and supply for the over-the counter medication.
Supplements are not nonprescription, over-the-counter medications approved by the Federal Drug Administration and are NOT applicable.
Nonprescription, over-the-counter medications approved by the Federal Drug Administration that require emergency medical service (EMS) notification after administration are NOT applicable.
Persons administering nonprescription, over-the-counter medication include licensed health personnel working under the auspices of the school and individuals, whom licensed health personnel have delegated the administration of medication with valid certification who have successfully completed a medication administration course approved by the department and annual medication administration procedural skills check.
- Districts stocking the administration of a voluntary stock of nonprescription, over-the-counter medications, collaborate with licensed health personnel to develop and adopt a protocol shared with the parent to define at a minimum:
  - when to contact the parent when a nonprescription medication, over the counter medication is administered;
  - documentation of the administration of the nonprescription, over-the-counter medication and parent contact;
  - a limit to the administration of a school’s stock nonprescription, over-the-counter medications that would require a prescriber signature for further administration of a school’s nonprescription, over-the-counter medications for the remaining school year;
  - the development of an individual health plan for ongoing medication administration or health service delivery at school.

I request that the above-named student receive the voluntary stock nonprescription, over-the-counter medications supplied by the school in accordance with the district guidelines and protocol.

__________________________________________ _________________________

Parent Signature Date

__________________________________________ _________________________

Parent/Guardian Address Home Phone

ddvorak@northl… Tue, 08/29/2023 - 10:07