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  • Flint Community Schools Health Services

  • 923 E. Kearsley St., Flint, MI 48503
    Phone: 810-424-4087
    Fax: 810-760-7032

  • ADMINISTRATION OF MEDICATIONS BY SCHOOL PERSONNEL PARENT INFORMATION

  • Dear Parents/Legal Guardians:
    Please complete the attached Medication Administration Authorization Form to enable us to aid you in the administration of your child's medication.
    The first dose of a new medication should be given at home so the student can be observed for possible side effects or reactions.
    We ask that you adhere to the following information as dictated by the state with recommendations from the district when sending medication of any kind to the school:

  • 1. Prescription medications will only be given with:

    • Signed medication administration authorization from parent/guardian.
    • Authorization of the health care provider (current pharmacy prescription label)
    Please note, changes in prescription must be accompanied by a written prescription and a new-signed medication administration authorization form.

  • 2. Medication must be in the most current original prescription bottle or box (i.e., inhaler) clearly labeled with:

    • Student's name
    • Name of medication
    • Current Date
    • Dosage and time to be given (A.M. dose should be given at home)
    • Route of administration (i.e. by mouth)
    • An expiration date
    • Name and phone number of health-care provider
    Most pharmacies will provide you with duplicate containers if you request them. Staff shall not be responsible for cutting, breaking or dividing tablets, capsules or pills.

  • 3. Non-prescription medication will only be given with:

    • Signed medication administration authorization from parent/guardian.
    • Written authorization by the health-care provider
    • Must be in the original container
    • Clearly labeled with student's name, dosage, and time to be given
  • Revised 6/24 jrh

  • 4. Sufficient supply should be sent to school to ensure enough medication is available to last for the prescribed length of time. Send a minimum of one week's supply.

  • 5. Failure to provide a sufficient amount of non expired emergency medication(s) for your student will result in the school being required to call 911 in cases of your child having a significant flare up of their condition during the school day. (i.e inhalers, Epi pens, seizure rescue medications)

  • 6. Medication, including refills, must be brought to school by an adult for safety reasons.

  • 7. In order to keep medications in our schools at a minimum, we request that you administer medication ordered three times a day or less at home, unless the health-care provider orders the medication to be given at a specific time during school hours as designated by school policy.
  • 8. A health care provider's written authorization is needed for medication to be carried on the student during school hours. A staff person designated by the building administrator will instruct the student of responsibilities involved and inform personnel of medication being carried. At no time shall a student provide, share, sell, or use another students' medications, whether prescription or non-prescription.

  • 9. The building administrator, or nurse, may discontinue the student's self-administration privileges upon advance notification to the parent/guardian.

  • 10. Discontinuation of medication requires a written physician or parental statement. Any leftover medication must be picked up by the parent/guardian.
  • 11. All food utensils (i.e., measuring device, crusher, etc.) needed to administer medication is to be supplied by the parent/guardian and clearly labeled with the student's name.
  • 12. All medication must be picked up by the parent/guardian at the end of the school year or it will be discarded.
  • 13. A new Medication Administration Authorization Form and a supply of medications are required each school year.
  • Please contact Health Services, at 810-424-4087, if you have any questions concerning medications policy and procedures.
  • Free or low-cost health coverage for children under the age of 19, or pregnant women of any age Call the MI Child and Healthy Kids hotline at 1.888.988.6300 or apply online at www.michigan.gov/mibridges Health care coverage & services for eligible people up to age 21 years and pregnant women exposed to the Flint water since April 2014 Call 1.855.789.5610 or apply online at www.michigan.gov/mibridges
  • Revised 6/24 jrh
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  • FLINT COMMUNITY SCHOOLS
  • FLINT COMMUNITY SCHOOLS
    HEALTH SERVICES
  • 923 E. Kearsley Street
    Flint, MI 48503
    Phone: (810) 424-4087
    Fax: (810) 760-7032

  • MEDICATION ADMINISTRATION AUTHORIZATION FORM(To be completed by Parent/Legal Guardian)

  • Form of Medication/Treatment: (circle)*
  • I, the undersigned parent or legal guardian, request that my child receives the above medication at school according to the school district's medication policy. I have reviewed the Flint Community Schools medication consent information. Furthermore, my request and permission for administration of medication constitutes my agreement to indemnify, hold harmless, and release the district, its employees and agents from any and all claims and liability arising from the administration of medications requested above. The physician's written instructions or a pharmacy-prepared container shall accompany the request. Written requests shall be renewed every school year.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • * Please initial below those items that apply
  • Date:*
     - -
  • Secretaries: If a child has Severe Allergies, Asthma, Diabetes or Seizures, a plan of Care/Care Plan must be completed and submitted by the parent and physician.
    Please fax a copy of all form(s) to Health Services at 810 760-7032
  • Revised 6/24 jrh
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