Valley View Jr. High

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Medical Authorization Form's

IMPORTANT FORMS
 
Asthma - Inhaler Authorization and Action Plan
 
If your child has asthma and requires an inhaler, please print out the asthma authorization form and take it to your child's physician. Please ask the physician to fill out the action plan to give your child's nurse additional instructions in the event your child needs assistance. If you would like your child to carry their inhaler with them, his/her physician must sign the authorization form granting this permission. We encourage an additional inhaler be provided to stay in the clinic.
 
PLEASE PRINT OUT THE ASTHMA ACTION PLAN IN THE ATTACHMENT BELOW PRESCRIPTION
 
Medication Authorization Form
 
Only medications that are required to enable a student to stay in school should be given at school. Medication to be given 3 times a day should be given before school, after school, and at bedtime unless a particular time is specifically noted by physician.
 
All medication should be in the original container and labeled with your child's name.
Please print medication authorization form (for more than one medication print out separate forms), fill it out, and bring it with the medication to the clinic.
 
 PLEASE PRINT OUT THE MEDICATION AUTHORIZATION IN THE ATTACHMENT BELOW
 
 
NON-PRESCRIPTION Medication Authorization Form
 
This is for non-prescription medications that is over the counter that you would like for us to give your child .
 
Please bring us the medication and please print and sign the form below in the attachment.
 
 
 
Severe Allergy - Medication Authorization and Action Plan
 
 If your child suffers from severe allergies that requires medication in the event of a reaction, please print out the authorization form to be filled out completely by you and your child's physician.
 
 If you and your child's physician want the child to carry their EpiPen, then specific notation should be made by the physician to authorize this.
 
PLEASE PRINT OUT THE ALLERGY ACTION PLAN IN THE ATTACHMENT BELOW
 
 
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