POLICY TITLE: Medication POLICY NO:

504.17
Minidoka County Joint School District # 331 PAGE 1 of 3

District Personnel shall not dispense medication except as set forth in this policy.

Provisions:
If a student must take medication during the school day, the following provisions will be adhered
to:

PRESCRIPTION MEDICATIONS
1. If a school is being asked to administer medication, the parent/guardian must submit a
completed district Medication Authorization Form which is available at each school
office. The prescribing doctor must sign the completed form.
2. The medication must be in the original container and brought to the school office by
the parent/guardian. Verification of the quantity of medication in the container will
be made by district personnel in the presence of the parent/guardian and logged on the
student’s charting record.
3. The student’s name, prescription number, doctor and directions must be clearly set
forth on the container.

NON-PRESCRIPTION (OVER-THE-COUNTER) MEDICATIONS

1. If a school is being asked to administer medication, the parent/guardian must submit a
completed district “Medication Authorization Form” which is available at each school
office
2. The medication must be in the original container and brought to the school office.

ADDITIONAL GUIDELINES
1. All medications to be administered by District personnel will be stored in a locked
cabinet.
2. It is the student’s responsibility to come to the office at the appropriate time to take
his or her medication, unless the student has a disability and is unable to do so.
3. No medication that a school is being asked to administer will be dispensed without a
completed district Medication Authorization Form on file.
4. Non-prescription medications, such as aspirin or Tylenol, will not be provided to
students upon request. Students must supply their own over-the-counter medications.
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LEGAL REFERENCE: Idaho Code Idaho Code 33-506(1) and §37-2701 et seq and
The Family Education Rights and Privacy Act of 1974

ADOPTED: July 18, 2005

AMENDED/REVISED:

ATTACHMENT: “Medication Authorization Form”

MINIDOKA COUNTY JOINT SCHOOL DISTRICT # 331

SECTION 500: STUDENT PERSONNEL

Insert—continued Page 2 of 3

Medication Authorization Form

PHYSICIAN SECTION

Student’s Name:
Diagnosis/Reason For Medication:
Name Of Medication:
Type Of Medication (tablet, liquid,
capsule, inhaler, insulin, injection, etc.):
Dosage:
Time(s) To Be Taken:
Specific Directions/Possible Side
Effects:

Please check the box below that applies to this student:

□ This student is both capable and responsible for self-administering this medication at school.
Furthermore, I certify that this student has been instructed in the use and self-administration of
the above medication. He/she understands the need for this medication and is able to use this
medication independently.

□ This student needs assistance of District personnel to administer this medication at school.

Physician Name:______________________________ Telephone Number:_______________

Physician Signature:___________________________Date:___________________________

PARENT/LEGAL GUARDIAN SECTION

Please check the box below that applies to this student:

□ I give permission for my child to self-administer the medication listed above.

□ I request that the above medication be administered to my child by District personnel.

I understand that any change in this prescription will necessitate a new medication authorization
form to be completed. I understand that administration of medication will be handled according
to Policy # 504.17. In accordance with the Family Education Rights and Privacy Act of 1974
(FERPA), I hereby give permission for Minidoka County Joint School District # 331 to release
to, obtain from or exchange with any appropriate person or agency, any confidential,

SECTION 500: STUDENT INDEX

Insert—continued Page 3 of 3

educational, psychological and/or medical information or records regarding my child thus

permitting District personnel to communicate with my child’s health care providers.

Parent/Legal Guardian Name:______________________________

Date:___________________________

SECTION 500: STUDENT INDEX