Medical Forms

  • DM form (‘Consent for Administration of Approved Discretionary Medications and Health Contact Information’):
  • As noted above, a new DM form must be completed each school year. Any forms from prior school years are invalid and cannot be used to approve medications.
  • As you complete a new form for your child, please be aware that we receive hundreds of forms during the first weeks of school, and it may take some time for to review all forms and update records or plans as needed. PLEASE CONTACT THE NURSE DIRECTLY FOR ANY NEW/SERIOUS HEALTH CONCERNS, OR IF YOU ARE UNSURE IF YOUR CHILD’S NECESSARY HEALTH ACCOMMODATIONS ARE IN PLACE
  • Additional information:
    • §only listed medications may be administered, and only in approved OTC doses (as per BCPS OHS annual standing order)
    • §only the school nurse may administer these medications; a health assistant or other staff member may not administer any medications if the Nurse is not present, or if not under direct training and delegation by the Nurse
    • students may not self-carry these medications
    • a new form is required to be completed every school year; any forms completed prior to 6/17/22 are invalid for the 2022-2023 school year
    • at the discretion of the School Nurse, a one-time courtesy call may be made to the parent/guardian to obtain verbal permission to administer a discretionary med; verbal consent must be followed up with a written, signed form in order for the student to receive medication in the future
    • form may be printed, completed, signed, and delivered to Nurse via email, fax, or student may drop off. Link to form:

    https://scs.bcps.org/UserFiles/Servers/Server_31979837/File/Departments/Social-Emotional%20Support/SSS/Health%20Services/BEBCO/BEBCO%200881-Consent-for-Admin-of-Approved-Disc-Meds%20Rev%202022.pdf

     

  • Medication Order Form (‘Parent’s Request to Administer Medication in School’):
    • ALL medications administered in school must be accompanied by an order form signed by both the parent and the approved provider (with the exception of an up-to-date parent/guardian signed DM form for approved discretionary meds). This includes any OTC meds not listed on the DM form.
    • If your child is prescribed a temporary medication (such as an antibiotic, eye drops, etc.) please have the provider complete this form. A written and signed order from the provider including all required information (student name, DOB, med, dose, route, time, frequency) may be substituted for the BCPS/State form. Link to form:

    https://scs.bcps.org/UserFiles/Servers/Server_31979837/File/Departments/Social-Emotional%20Support/SSS/Health%20Services/BEBCO%202804%20Medication%20for%20Students%20in%20School%20Rev%2017%20Accessible.pdf

  • Consent for Release of Records form:
    • If you would like records or information shared with a provider, please complete this form. Please included details of what specific information, contact information for provider, and method of communication

https://go.boarddocs.com/mabe/bcps/Board.nsf/files/BYYND75E5503/$file/RULE%205230-Form%20A_052416_Finalized.pdf