Prescription Medication

*Prescription medication must be in a container labeled by the pharmacist or prescriber.
*An adult must bring the medication to the school.
*It is the parent’s responsibility to provide the correct amount of medication so that it is available when needed.
*The very first dose of this medication cannot be administered at school.
*The school nurse (RN) may call the prescriber, as allowed by HIPAA, if a question arises about the child and/or the child’s medication.

With full knowledge of any emergencies, dangers, and risks related to the administration of such medication by Bright School, I, the undersigned, hereby waive all claims which might arise from said medication to said minor child and the result thereof. I agree to indemnify and hold harmless Bright School, its members, officers and employees from any and all liability relative to the administration of such medication.

I understand that I must submit a revised statement and sign it if any information/conditions change (either medication OR dosage). It is requested that the parent/ legal guardian sign below.

NOTE: Under Tennessee state law, prescription medication must be brought in the original, pharmacy labeled container. The container shall display:

• Child's Name
• Prescription Number
• Medication Name and Dosage
• Administration Route or Other Directions
• Date
• Licensed Prescriber's Name
• Pharmacy Name, Address, and Phone Number

Prescription Number Medication Name and Dosage Administration Route or Other Directions