POLICY NO. 5140 MEDICAL ALERT AND ADMINISTERING MEDICATION TO STUDENTS POLICY Schools must maintain up-to-date information on any student who has a medical condition that may require emergency care at school. Students who are on medication which they have to take during school hours should be treated with the utmost care. In order to avoid any confusion over what is or is not required, the following regulations for the administration of medication should be STRICTLY adhered to. ADOPTED: December 8, 1998, Amended: Nov. 13, 2007 Page 1 of 6
POLICY NO. 5140 MEDICAL ALERT AND ADMINISTERING MEDICATION TO STUDENTS REGULATIONS 1. Schools will ensure that they implement a system to obtain current information on any student who has a medical condition that may require emergency care at school. The Medical Alert System form will be used. 1.1 Such information will be updated annually. 2. The Medical Alert System should ensure that staff are aware of the student s condition and are familiar with the appropriate action to take if required. 3. If it is required that a student take medication during school hours the school should ensure that the Request for Administration of Medication at School form has been completed. 4. Teachers shall not be called on to administer medication on a regular or predictable basis. Exceptional circumstances will be discussed with the Association. 5. In an emergency situation, an employee of the Board is expected to act as a responsible parent might in the administration of medication in any form to a child. ADOPTED: December 8, 1998, Amended: Nov. 13, 2007 Page 2 of 6
MEDICAL ALERT SYSTEM Student Name: Date of Birth: Y / M / D Personal Health Care No. (from Care Card) Parents Names: Telephone: Home: Mother s Work: Father s Work: Other Name and Phone Number: Name of Physician: Physician s Phone: Indicate what medical condition this student has that may require emergency care at school: Describe the potential problem (include symptoms that might be observed): Continued on reverse... THIS FORM MUST BE COMPLETED AT THE START OF EACH SCHOOL YEAR Please check the signature / date at the end of this form to ensure it is current Destroy all outdated forms ADOPTED: December 8, 1998, Amended: Nov. 13, 2007 Page 3 of 6
Describe the necessary action or intervention to appropriately treat this medical condition: Step 1: Step 2: Step 3: Step 4: Step 5: Is medication needed? YES NO If yes, what medication (circle one) Parents must complete a REQUEST FOR ADMINISTRATION OF MEDICATION FORM which is also available from your school. Parents need to ensure that this medication does not go past its expiry date. It is the obligation of the parents to keep a current supply of any required medication at the school. If training is required to administer the medication such as with an EpiPen (auto injector) please identify who will do the training and the date training is completed. Please be aware that parents are most often the trainer. If assistance from the Public Health Nurse is required please call the Health Unit to make arrangements. Training on: Name of Trainer: People Trained: Print Name Signature Date Print Name Signature Date Print Name Signature Date Signature of Parent Date THIS FORM MUST BE COMPLETED AT THE START OF EACH SCHOOL YEAR ADOPTED: December 8, 1998, Amended: Nov. 13, 2007 Page 4 of 6
REQUEST FOR ADMINISTRATION OF MEDICATION AT SCHOOL A. To be completed by parent or guardian. Name Birth Date (Y/M/D) Parent or Guardian Home Phone Business Phone Physician Phone B. To be completed by prescribing physician LIST CONDITION(S) WHICH MAKE MEDICATION NECESSARY NAME OF MEDICATION DOSAGE DIRECTIONS FOR USE Additional Comments (possible reactions, consequences of missing medication, etc.) Physician s Signature / Date C. To be completed by parent/guardian I request the school give medication as prescribed in the upper section of this form to my child whose name is recorded below. Name of Child I will notify the school promptly of any changes in medications ordered. Date Signature of Parent/Guardian Continued on reverse... ADOPTED: December 8, 1998, Amended: Nov. 13, 2007 Page 5 of 6
D. Each school staff member who is responsible for the administration or supervision of the medication must review the information on this card then date and sign below. Date Signature Comments ADOPTED: December 8, 1998, Amended: Nov. 13, 2007 Page 6 of 6