JGFGBA Student Self-Administration of Medications (See JGFGB) JGFGBA
The self-administration of medication is allowed for eligible students in grades K–12. As used in this policy medication means a medicine for the treatment of anaphylaxis or asthma including, but not limited to, any medicine defined in current federal regulation as an inhaled bronchodilator or auto-injectible epinephrine. Self-administration is the studentŐs discretionary use of an approved medication for which the student has a prescription or written direction from a health care provider.
As used in this policy health care provider means a physician licensed to practice medicine and surgery; an advanced registered nurse practitioner, or a licensed physician assistant who has authority to prescribe drugs under the supervision of a responsible physician.
An eligible student shall meet all the following requirements:
1. A written statement from the studentŐs health care provider stating the name and purpose of the medication/s;
2. The prescribed dosage;
3. The time the medication is to be regularly administered;
4. Any additional special circumstances under which the medication is to be administered;
5. The length of time for which the medication is prescribed;
6. The student shall also
demonstrate to the health care provider or the providerŐs designee and the
school nurse or the nurseŐs designee the skill level necessary to use the
medication and any device that is necessary to administer the medication as prescribed.
In the absence of a school nurse, the school shall designate a person who is
trained to witness the demonstration.
The health care provider shall prepare a written treatment plan for managing the studentŐs asthma or anaphylaxis episodes and for medication use by the student during school hours. The studentŐs parent or guardian shall annually complete and submit to the school any written documentation required by the school, including the treatment plan prepared by the studentŐs health care provider. Permission forms shall be updated during enrollment.
All teachers responsible for the studentŐs supervision shall be notified that permission to carry medications and self-administer has been granted. The school district shall provide written notification to the parent or guardian of a student that the school district and its officers, employees and agents are not liable for damage, injury or death resulting directly or indirectly from the self-administration of medication.
Waiver of Liability
studentŐs parent or guardian shall sign a statement acknowledging that the
school districts and its officers, employees or agents incur no liability for
damage, injury or death resulting directly or indirectly from the
self-administration of medication and agreeing to release, indemnify and hold the
schools and its officers, employees and agents, harmless from and against
any claims relating to the self administration of medication allowed by this policy.
The parent or guardian of the student shall sign a statement acknowledging that the school incurs no liability for any injury resulting from the self-administration of medication and agreeing to indemnify and hold the school, and its employees and agents, harmless against any claims relating to the self-administration of such medication.
á The school district shall require that any back-up medication provided by the studentŐs parent or guardian be kept at the studentŐs school in a location to which the student has immediate access if there is an asthma or anaphylaxis emergency;
á The school district shall require that all necessary and pertinent information be kept on file at the studentŐs school in a location easily accessible if there is an asthma or anaphylaxis emergency;
á Eligible students shall be allowed to possess and use approved medications at any place where the student is subject to the jurisdiction or supervision or the school district, its officers, employees or agents;
á The board
may adopt policy or handbook language which imposes additional requirements
relating to the self-
administration of medication allowed for in this policy and may establish a procedure for, and the conditions under which, the authorization for student self-administration of medication may be revoked.
BOE Approval June 10, 2009
Permission for Self-Administration of Medication
Name of Student ________________________________________________ School_____________________________Grade _______________________ Teacher ________________________________________________________ Medication _________________________Dosage ______________________ Date Started _____________________________________________________ Conditions under which the medication is to be given:
Any additional circumstances under which the medication is to be given:
Length of time medication is to be administered:
I hereby give my permission for (name of student) to administer the above medication at school as ordered. I understand that it is my responsibility to furnish this medication. I acknowledge that the school incurs no liability for any injury resulting from the self-administration of medication and agree to indemnify and hold the school, and its employees and agents, harmless against any claims relating to the self-administration of such medication.
My child has been instructed on self-administration of the
medication and is authorized to do so in school.
Signature of Parent or Guardian
[NOTE: Parental permission must be renewed annually]
Signature of Health Care Provider