Medication Authorization 

Independent Carry Form

Information for proper forms to fill out for out of state or extended stay field trips.  Please let Mrs. Hager know ASAP if your child will need to take a medication on a field trip that they normally take at home, but not at school.  The child's provider will need to write orders for the school for those medications as well. 

Instructions for Medications Needed on Out of State or Extended Field Trips:

Please have your child’s doctor complete the form INDEPENDENT MEDICATION CARRY AND USE for your child to be “independent to carry and administer” any medications needed AND have him/her fill out the Administer Medication form.  The doctor may fax those orders to  699-5424.

Parents MUST sign the independent medication carry and use permission slip stating they give permission for their child to independently carry and administer their medication while on the field trip. This is the bottom portion of the INDEPENDENT MEDICATION CARRY AND USE Form.

The school nurse will meet with your child to ensure he/she knows exactly how to take their medication properly before the student can officially be able to self carry and self administer their medication.

Parents must provide prescription medication (prepared by student’s pharmacy) and OTC (over the counter medicine) to the nurse prior to the field trip.

Parents, whose students will require medications for the trip which they do not require on a daily basis at school, should obtain physician orders and provide the medication as above.

This includes OTC (over the counter medicine) for example: Zyrtec, Tylenol or Motrin, Midol, Tums, etc. All medications must be in labeled, original container.

There must be a separate doctor signed Administer Medication Form for each separate medication.

If you have any questions or concerns, please call the school nurse, Karin Hager,  at 699-2318 #4 to reach the Health Office.