Immunizations & Medication Forms & Headlice Information

Click here for the **Asthma/Medication Authorization Form**– Required for students who need any type of medication or asthma inhaler at school. Even over-the-counter medication such as Tylenol requires this form to be filled out and signed by a physician, and submitted to the school office.

 

STUDENT MEDICATIONS POLICY

The following is a summary of Murray School District Policy PS 437 concerning student medication.

 

  1. Upon receipt by the school principal or designated school official of a complete written authorization, documented on a specific form furnished by the District (see attached forms), and signed by the student’s parents/guardian, the school will provide a safe storage place for the medication to be dispensed to the student, with the exception of self-administered inhaled asthma medication, self-administered diabetes medication, and self-administered epinephrine auto-injector. The written authorization shall contain the following information:
    • Name of student and date of birth;
    • Written consent from the parent or guardian to dispense the medication;
    • Name, address, and office telephone number of the physician prescribing the medication;
    • Name, address, and home and business telephone numbers of parent/guardian;
    • Name of drug, dosage, and time to be administered;
    • List of any side effects, provided by the doctor or pharmacist, which can or may occur due to the use of the drug with the necessary procedures to follow in case of a reaction.
  2. The parent request and prescriber’s statement must be resubmitted each school year the medication is to be continued. The school may dispense medication based on previous year’s request for up to ten school days, if necessary, to allow the student’s parent/guardian time to obtain the prescriber’s signed statement for the current school year.
  3. The prescription drug to be dispensed must be delivered in the original container with the date it was dispensed, name, address, and telephone number of the pharmacy printed on the container.
  4. All over-the-counter medication must contain instructions and a signature from the attending physician, written consent to dispense the medication from the parent/guardian.
  5. The school will not accept or dispense any medication delivered to the school by the student, without the correct signed and authorized paperwork.
  6. No changes in the dosage or medication will be allowed unless authorized in writing by the physician. The authorization must be dated and signed by the prescribing physician and include any instructions necessary for administering the medication.

 

ASTHMA INHALERS

This policy applies to all medications with the exception of self-administered inhaled asthma medication. A separate form must be completed and signed by both the physician and parent/guardian.

Click here for the **Asthma/Medication Authorization Form**

If you have any questions regarding student medication authorization, please contact your school principal or the Director of Student Services at the District Office.

Revised 9/15

 

IMMUNIZATIONS

Kindergarten Immunizations Requirements

Seventh Grade Immunizations Requirements

HEAD LICE INFORMATION at Utah Department of Health