Requirements to Self-Administer and Self Carry Medication
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Requirements for Students to Self-Administer/Self Carry Medication During the School Day or at School Sponsored After School Events
Dear Parent/Guardian: ▁▁▁▁▁▁▁▁▁▁▁▁ Date: ▁▁▁▁▁▁
Student Name: ▁▁▁▁▁▁▁▁▁▁▁▁ Teacher: ▁▁▁▁▁▁▁▁▁▁▁▁ Grade: ▁▁▁▁▁▁
If school nursing personnel receive a request from a parent/guardian and licensed prescriber to permit a student to carry and self-administer their own prescribed medications, such decisions will be made on an individual basis and in accordance with the following criteria:
• The health care problems are severe enough to self-carry (particularly asthmatic or allergic conditions)
• The licensed prescriber has provided an order directing that the student be allowed to carry their medication and self-administer
• The parent/guardian has requested permission for the student to self-carry, self-administer
• The parent/guardian assume responsibility regarding the monitoring of the student on an ongoing/daily basis to ensure that the student is carrying and taking the medication as ordered
• The student demonstrates compliance in consistently and responsibly taking their own medication
• The student assumes the responsibility for carrying properly labeled medication in original container on his/her person or keeping in school or physical education locker.
• The school nurse has completed a nursing assessment which documents the student’s competence in self-carry, self-administration. Sample criteria attached – see page 2This privilege may be reassessed or revoked if the student cannot consistently and responsibly take their own medication.
Thank you in advance for your cooperation,
School Nurse: ▁▁▁▁▁▁ School:▁▁▁▁▁▁
Phone #:▁▁▁▁▁▁ Fax:▁▁▁▁▁▁ Email:▁▁▁▁▁▁
Determination of Self-Directed Students Criteria for Consistently and Responsibly Taking Medication
The student:
- Recognizes his/her medication
- Knows how much medication he/she takes
- Know what time his/her medication is needed during the school day
- Knows why he/she takes this medication
- Knows what happens when he/she does not take their medication
- Knows when to refuse to take his/her medication when appropriate
- Knows how to self-administer medication from original labeled pharmacy container or original OTC container (or is able to direct staff member to assist)