This form is use for daily medications and for medications that are needed on an "as needed" basis. This form needs to be completed and returned to your child's school nurse prior to administration of medication.
SELF-ADMINISTRATION MEDICATION FORM:
This form is use for self administration medication such as asthma inhalers, epi-pens, and insulin. This form is for Rush, Middle and High school students only.
Severe Allergies/ Anaphylaxis Forms
All parents should read the Emergency Med Parent Guardian Letter found below. In addition, ALL of the following forms must be submitted to the school nurse:
- Individual Healthcare Plan for Severe Allergies/Anaphylaxis: Any student that is required to carry an epi-pen for severe allergies/anaphylaxis should have this healthcare plan completed and signed by the student's physician and parent/ guardian.
- Epi-pen Delegate Permission Form: Students with severe allergies must have this form filled out and signed by parent/guardian. This form is used for permission or refusal to appoint a delegate to administer the epi-pen to students with severe allergies.
- Request for Administration of Medication
- FARE Food Allergy & Anaphylaxis Emergency Care Plan (in English or Spanish)
- Parent Form Checklist Allergy Emergency
- One of the Administration of Medication Forms - either self-administer or not
- Notice of Allergy Supervision and Training
INDIVIDUAL FORMS for SEVERE ALLERGIES / ANAPHYLAXIS: