507.2 - Administration of Medication to Students

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 will 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.

When administration of the medication requires ongoing professional health judgment, an individual health plan will developed by an authorized practitioner with the student and the student's parent. Students who have demonstrated competence in administering their own medications may self-administer their medication. A written statement by the student's parent will on file requesting co-administration of medication, when competence has been demonstrated. By law, students with asthma or other airway constricting diseases 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 will include authorized practitioners, such as licensed registered nurses and physician, and persons to whom authorized practitioners have delegated the administration of medication (who have successfully completed a medication administration course). A medication administration course and periodic update will be conducted by a registered nurse or licensed pharmacist, and a record of course completion will maintained by the school.

A written medication administration record will 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 will be stored in a secured area unless an alternate provision is documented. Emergency protocols for medication-related reactions shall be posted. Medication information will be confidential information as provided by law.

Disposal of unused, discontinued/recalled, or expired medication will in compliance with federal and state law. Prior to disposal school personnel will 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 will be in accordance with the disposal procedures for the specific category of medication.

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.
  281 IAC §41.404(1)(f), (3)(f)
                                      657 IAC §8.32(124); §8.32(155A).
                                      655 IAC §6.2(152).

Cross Reference: 506     Student Records
                                      507     Student Health and Well-Being
                                      603.3 Special Education
   607.2 Student Health Services

Approved: Aug. 9, 2004, Sept. 22, 2014, November 26, 2018
Reviewed: Aug. 24, 2005, Oct 28, 2013, Oct. 15, 2018
Revised: Dec.13, 2010, Aug. 25, 2014, Oct. 15, 2018

dawn.gibson.cm… Thu, 11/18/2021 - 09:18

507.2E1 - Authorization - Asthma or Airway Constricting Medication Self-Administration Consent Form

__________________________________ ____/___/___ __________________ ___/___/___
Student’s Name (Last), (First) (Middle) Birthday School Date

In order for a student to self-administer medication for asthma or any airway constricting disease:

Parent/guardian provides signed, dated authorization for student medication self-administration.
Physician (person licensed under chapter 148, 150, or 150A, physician, physician’s assistant, advanced registered nurse practitioner, or other person licensed or registered to distribute or dispense a prescription drug or device in the course of professional practice in Iowa in accordance with section 147.107, or a person licensed by another state in a health field in which, under Iowa law, licensees in this state may legally prescribe drugs) provides written authorization containing:

-purpose of the medication,

-prescribed dosage,

-times, or

-special circumstances under which the medication is to be administered.

The medication is in the original, labeled container as dispensed or the manufacturer’s labeled container containing the student name, name of the medication, directions for use, and date.
Authorization is renewed annually. If any changes occur in the medication, dosage or time of administration, the parent is to notify school officials immediately. The authorization will be reviewed as soon as practical.

Provided the above requirements are fulfilled, a student with asthma or other airway constricting disease may possess and use the student’s medication 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.

Pursuant to state law, the school district or accredited nonpublic school and its employees are to incur no liability, except for gross negligence, as a result of any injury arising from self-administration of medication by the student. The parent or guardian of the student shall sign a statement acknowledging that the school district or nonpublic school is to incur no liability, except for gross negligence, as a result of self-administration of medication by the student as established by Iowa Code § 280.16.

_______________ ___________ _______________________ ____________
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 or other airway constricting disease medication(s) at school and in school activities according to the authorization and instructions.
I understand the school district and its employees acting reasonably and in good faith shall incur no liability for any improper use of medication or for supervising, monitoring, or interfering with a student’s self-administration of medication.
I agree to coordinate and work with school personnel and notify them when questions arise or relevant conditions change.
I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment.
I agree the information is shared with school personnel in accordance with the Family Educations Rights and Privacy Act (FERPA).
I agree to provide the school with back-up medication approved in this form.
(Student maintains self-administration record.) (Note: This bullet is recommended but not required.)

_________________________________________ _______/_______/_______
Parent/Guardian Signature Date

(Agreed to above statement)

_________________________________________ ______________________
Parent/Guardian Address Home Phone

______________________
Business Phone

_____________________________________________________________________________

Self-Administration Authorization Additional Information

Approved: November 26, 2018
Reviewed: Aug.25, 2014, Oct. 15, 2018
Revised: Oct. 15, 2018

dawn.gibson.cm… Thu, 11/18/2021 - 09:24

507.2E2 - Parental Authorization and Release Form for the Administration of Prescription Medication to Students

___________________________________ ___/___/___ _________________ ___/___/___
Student's Name (Last), (First) (Middle) Birthday School Date

School medications and health services are administered following these guidelines:

Parent has provided a signed, dated authorization to administer medication and/or provide the health service.
The medication is in the original, labeled container as dispensed or the manufacturer's labeled container.
The medication label contains the student’s name, name of the medication, directions for use, and date.
Authorization is renewed annually and immediately when the parent notifies the school that changes are necessary.

Medication/Health Care Dosage Route Time at School

Administration instructions

Special Directives Signs to observe and Side Effects

/ /
Discontinue/Re-Evaluate/Follow-up Date

/ /
Prescriber’s Signature Date

Prescriber's Address Emergency Phone

I request the above named student carry medication at school and school activities, according to the prescription, instructions, and a written record kept. Special considerations are noted above. The information is confidential except as provided to the Family Education Rights and Privacy Act (FERPA). I agree to coordinate and work with school personnel and prescriber when questions arise. I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment.

/ /
Parent's Signature Date

Parent's Address Home Phone

Additional Information Business Phone

Authorization Form

Approved: November 26, 2018
Reviewed: Aug.25, 2014, Oct. 15, 2018
Revised: Oct. 15, 2018

dawn.gibson.cm… Thu, 11/18/2021 - 09:20