Medication Forms

Medication Form (Click link below)

Medication Form

At times it may be necessary for your child to receive medication during the school day. For the safety of all students, School Health Services strictly enforces the School District of Prairie Farm Medication Policy. Please do not ask the school nurse or licensed secretary to make an exception to the policy.

All prescription and over-the-counter medication (including cough drops, Tylenol, Advil, cold and cough preparations) must be administered by the school nurse or licensed secretary in the school clinic.

All medication must be in the original, unopened bottle.

A parent/guardian must transport needed medication to school. It cannot be sent with the child.


Prescription Medication Policy

Written parental permission is required before any medication may be administered. 

A physician's order and signature must accompany prescription medications along with the parent's signature on the permission form.

Medication must be in the original prescription bottle with the child's name, medication, dosage, time and amount to be given.

Over-the-count Medication Policy

Tylenol, Advil, cold and cough preparations, cough drops, etc. must be administered in the school clinic under the direction of the school nurse or licensed secretary.

Written permission from the parent stating the name of the medication, amount of medicine to be given, frequency and reason for medication to be administered must be provided on the medication form. Click on the Non-RX form on the right to print the prescribed medication form.

Medicine must be in the original, unopened, sealed container. The school nurse and licensed secretary may not dispense medicine from a previously opened bottle.

Any over-the-counter medicine administered for more than 3 consecutive school days must be authorized by the physician/nurse practitioner in writing.