We can dispense ibuprofen/acetaminophen to a student on an as-needed basis
PHONE NUMBER FOR EMERGENCY PHONE TREE (for school wide emergency only) Phone #: _____________________________________ DISPENSING IBUPROFEN/ACETAMINOPEN PERMISSION FORM (This section is NOT OPTIONAL)
Please check one of the choices, sign and date We can dispense ibuprofen/acetaminophen to a student on an as-needed basis. Please check the following instructions according to your wishes.
__________ Do dispense ibuprofen/acetaminophen to my student if needed.
__________ Do not dispense ibuprofen/acetaminophen to my student.
Student Name________________________________________________________ Parent Signature_________________________________ Date________________
PROCEDURE FOR STUDENT MEDICATIONS
We ask that our parents bring all student medications to the appropriate division office. All medications must be labeled with the name of the student, the name of the medication, and all necessary instructions. All medications must be taken by the student in the office under the supervision of an Oak Hall staff member. It is the responsibility of the student to remember his/her medication. The following form provides your authorization to a staff member of Oak Hall School to dispense any required medications to your student. Please complete the form and return to the school before the first day of classes. We cannot dispense medications until the form is on file in our office. Student Name ___________________________________________________________ Name of Medication(s) __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________
Dosage and times __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Special Instructions __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Name of Attending Physician ______________________________________________
Telephone Number___________________________________________ Parent Signature _________________________________ Date __________________
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