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H.S. 69-86/R 5/01

CARROLLTON-FARMERS BRANCH ISD

Health Services

Dear Physician:

We have received a request from a parent that a patient of yours be permitted to carry prescription medication on his person at school. Our school district policy states that “prescription medication shall be stored in the clinic or office area in a locked container”. The board policy does grant an exception to the storage of medication when the district has on file documentation from a physician attesting that a life threatening condition exists for a student.

This policy offers, to the best of the district’s ability, protection and safety for all students, including your patient. The school district cannot insure correct medication dosage, dispensation, and monitoring of a student with a health problem if the medication is being taken by the child out in the school building. It is Health Services’ belief that any student who has signs and symptoms of a presenting health problem should come immediately to the clinic where the student can receive the medication under standardized procedures and be monitored by the school nurse or designated personnel knowledgeable of the child’s condition. Self-administration of medicine by students without needed assistance is not considered an emergency situation. However, a student who has a life threatening condition and cannot reach the clinic in time, must have quick access to emergency medication and must be identified for emergency procedures.

Along with our concern for the welfare of your patient, the school district must account for the safety of the other students. The potential possibility of another child taking the medication you prescribed for your patient may pose a health threat for that student as well as legal implication for involved parties. Allowing a student to carry medicine in the classroom may also indicate to classmates that carrying drugs is permissible. With the mounting nation concern over illegal drugs, Health Services supports appropriate medication procedures, teaching pupils responsible health consumerism, and limiting drug access among students.

If your patient has a life threatening condition and you deem it essential that the medication be carried at all times by the student, please complete, along with the parent, the information on the back page and submit it to the building principal. Your request will receive immediate attention. The well-being of this student is of utmost concern to the school.

Sincerely,

Terri Lyons, RN

Nurse Manager

PHYSICIAN/PARENT REQUEST

FOR A STUDENT TO CARRY MEDICATION

Student’s Name: ___________________________________________ Age: ________________

Name of School __________________________________________________ Grade _______________

Life threatening condition for which medication is essential ______________________________________________________________________________________

______________________________________________________________________________________

Medication: __________________________________________________

Dosage: _____________________________________________________

Signs/symptoms indicating need for medication: ______________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________

Emergency action to take following medication:

Physician’s name _____________________________________	Telephone number: _______________________
Parent’s name _______________________________________	Home number: ___________________________ Work number: ___________________________
Preferred hospital: ______________________________________________________________________________

Emergency instruction to school personnel: ____________________________________________________________________________________________________________________________________________________________________________

Documentation of last life threatening situation: ______________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________

I deem it essential that my patient/child carry on his person the above prescribed medication at all times as this is a life threatening condition.

________________________________________

Physician’s Signature and Date

________________________________________

Parent’s Signature and Date

Please return this form to your building nurse.

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Office Use Only

Date: ___________________________________	Comments: _______________________________
Request Approved: ________________________	_________________________________________
Request Denied: __________________________	_________________________________________