School Nurse Forms (printable)

School Nurse Forms


Many students have a chronic disease that requires them to take medication regularly at school or will have to take a short-term medication during school hours for an acute problem, such as antibiotics for strep throat. The school nurse can give these medications and watch for any side effects or other complaints. Medications must be brought to the school nurse in the original container by an adult.

Prescription Medications

If your child has a prescription medication that needs to be taken at school, please bring it to school in the original bottle with a pharmacy label after the first dose has already been given at home. A second bottle with a pharmacy label will be needed to send medicine on a field trip. A parent or guardian should bring medication to the school, and it should be given directly to the school nurse, so that both the guardian and the nurse sign for it. The school nurse will also need a form signed by the provider who ordered the medicine before it can be given at school. Children with diabetes, asthma, seizures, severe allergies or any other medical condition that might be life-threatening and who have emergency medications from their doctors should have access to the emergency medication both at home and school. Physicians and parents can decide together if the child is ready to keep their emergency medication (such as an inhaler) or if it should be stored in the nurse’s office. The school nurse cannot give any medicine that is expired. At the end of the school year, you will be asked to pick-up extra medicine – the school nurse will throw out any medicine left in the clinic at the end of the school year.

Over-the-Counter (OTC) Medications

*Only students who have a signed consent on file giving permission for medications can receive any medications from the school nurse. Please see forms section above.

The following medications are provided by the health department and can be given based on the assessment performed by the school nurse:

  • Acetaminophen (Tylenol)
  • Ibuprofen (Advil/Motrin)
  • Robitussin DM (cough syrup)
  • Cough drops
  • Antacid (Maalox or Mylanta, Tums)
  • Anti-Nausea Medicine (Emetrol)
  • Aloe Vera (for burns)
  • Orajel
  • Claritin (Loratadine – for allergies)
  • Sore Throat Spray
  • Calamine Lotion
  • Sun Screen
  • Benadryl (antihistamine) *only given for severe allergic reaction
  • Bacitracin (antibiotic) Ointment
  • Hydrocortisone Cream (for skin irritation)
  • Blistex/Carmex (for chapped lips)

Over-the-counter (OTC) medication can only be given three days in-a-row without the order of a health care provider. If a parent wants their child to have access to an OTC medication that is not provided in the nurse’s office, they can provide the medication in its original container along with a note that gives permission for their child to take the medication.


Please ensure that the school has a copy of your child’s updated immunization record. If your child needs a vaccine, the school nurse will send home a letter that states which vaccine is needed. Children without insurance or with Medicaid can receive these immunizations at school with parent permission.

Chronic Disease and other Special Healthcare Needs

Please tell the school and school nurse if your child has any special health care needs. Students with a history of asthma, diabetes, seizures, or a severe allergy should have an Action Plan filled out and signed by their health care provider and the parent. Also, if your child has an emergency medication (inhaler, glucagon, Diastat, or EpiPen), please make sure that there is an extra at the school so that your child can use it during the school day.