We are also adding the Self-carry agreement form which must be completed by student, parent and school nurse when a student carries those emergency medications. As required by Ohio law, backup Epi-pens must also be stored in the clinic in the event that the student misplaces or loses the Epi-pen that they have been permitted to carry. This is an agreement between student, parent and school nurse to safely carry and self-administer Epi-pen or inhaler or both as needed during the school day and for extra-curricular activities.
Form to be completed by parent and physician in regards to specific information on the treatment of a child with a food allergy in the event of a possible ingestion of offending food.
Another example of an Emergency Action Plan for a suspected or active food allergy reaction created by the Food Allergy and Anaphylaxis Network, FARE.
Detailed description of information for parents and students in order to safeguard the child at school when diagnosed with a food allergy.
This is a medication form specifically intended to be used only two to three times during the school year for the OTC medications listed on the form. Please note that these medications are provided by the school in tablet form only. Thus, if your child needs liquid or chew-able Benadryl or other medications, the parent must provide those medications.
All medications prescribed by the physician must use the Authorization for Prescription medication form. Please contact the school nurse in your child's building with any questions or concerns that you might have.
Authorization for Student Possession and Use of emergency medications such as an Epi-pen and/or inhaler. This form also includes a Self-Carry agreement that must be completed by student and parent.
Please note that Ohio law requires that an additional Epi-pen be stored in the clinic when a student carries an Epi-pen in the event that the Epi-pen has been lost or misplaced or left at home or an additional dose is needed prior to the arrival of the paramedics.
Please note that you will find several medication forms for students with food allergies. The first form is the standard form for the administration of any prescription medication at school by school personnel such as Epi-pens and inhalers and those medications are stored in the clinic. In addition, when a physician and the parent determines that it is now in the best interest of the student to carry or keep the emergency medications on their person, the Student Possession form must be completed.