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. Administration of medication may also occur consistent with board policy 804.05 – Stock Prescription Medication Supply.
When administration of the medication requires ongoing professional health judgment, an individual health plan shall be developed 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 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, 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.
Persons administering medication shall include authorized practitioners, such as licensed registered nurses and physicians, and persons to whom authorized practitioners have delegated the administration of medication (who have successfully completed a medication administration course conducted by a registered nurse or pharmacist that is provided by the department of education). The medication administration course is completed every five years with an annual procedural skills check completed with a registered nurse or a 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. The development of emergency protocols for medication-related reactions is required. Medication information shall be confidential information as provided by law.
Disposal of unused, discontinued/recalled, or expired abandoned 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.
Note: This is a mandatory policy.
NOTE: Iowa law requires school districts to allow students with asthma, airway constricting disease or respiratory disease to carry and self-administer their medication as long as the parents and prescribing physician report and approve in writing. Students do not have to prove competency to the school district. The consent form, see 507.2E1, is all that is required. School districts that determine students are abusing their self-administration may either withdraw the self-administration if medically advisable or discipline the student, or both.
NOTE: School districts may stock over-the-counter, nonprescription medications that are not for life- threatening incidents. The policy for medication administration covers prescription and nonprescription medication.
NOTE: Disposal procedures reflect the Iowa Department of Education School .Hazardous Waste and Medication Management Guidance, issued 2021-2022: https://www.iowadnr.gov/Portals/idnr/uploads/waste/swfact_schoolhazardou...
Legal Reference: Disposing on Behalf of Ultimate Users, 79 Fed. Reg. 53520, 53546 (Sept. 9, 2014).
Iowa Code §§124.101(1); 147.107; 152.1; 155A.4(2); 280.16; 280.23.
655 IAC §6.2(152).
281 IAC §14.1, .2
Cross Reference: 506 Student Records
507 Student Health and Well-Being
603.3 Special Education
607.2 Student Health Services
Approved 2-18-03 8-21-23 Reviewed 4-21-08 3-25-14 1-28-19 11-22-21 11-20-23 Revised 8-21-23
_____________________________ ___/___/___ _________________ ___/___/___
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 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 following must occur for a student to self-administer asthma medication, bronchodilator canisters or spacers, or other airway constricting disease medication or to self-administer an epinephrine auto-injector:
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, AIRWAY CONSTRICTING, OR RESPIRATORY DISTRESS MEDICATIONSELF-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 medication, bronchodilators canisters or spacers, 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.
______________________________________________________ _________/________ /___________
Parent/Guardian Signature Date
(agreed to above statement)
______________________________________________________ ______________________________
Parent/Guardian Address Home Phone
______________________________
Business Phone
Self-Administration Authorization Additional Information
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 special health services are administered following these guidelines:
__________________ ________ ________ _____________
Prescribed Medication Dosage Route Time at School
Special Health Services and instructions, in indicated:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
___________ / ___________ / _____________
Discontinue/Re-Evaluate/Follow-up Date for Prescribed Medication or Special Health Services listed
____________________________________________ ___________ / ___________ / _____________
Prescriber’s Signature Date
And credentials (when indicated for health service delivery)
____________________________________________ ___________ / ___________ / _____________
Parent/Guardian Signature Date
_______________________________________ __________________________
Parent/Guardian address Home phone
PARENTAL AUTHORIZATION AND RELEASE FORM FOR THE ADMINISTRATION
OF MEDICATION OR SPECIAL HEALTH SERVICES TO STUDENTS
/ /
Parent's Signature Date
Parent's Address Home Phone
Additional Information Business Phone
Authorization Form
_________________________________ ___/___/___ _________________ ___/___/___
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
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)
Other: ____________________ administered per manufacturer label (Please Specify)
Other: ____________________ administered per manufacturer label (Please Specify)
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 of 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