Prescription Medication Authorization form
OTC (Over-the-counter) Authorization form
OTC (Over-the-counter) Field Trip Medication Authorization form
What do I do if my child needs to take medication at school?
For a prescription medication to be taken at school, the Prescription Medication Authorization form needs to be filled out and signed by your child’s doctor. Once that is completed, the parent/guardian needs to sign the form and bring it (and the medication) to your child’s school clinic. If it is an over-the-counter medication, the parent/guardian needs to fill out the OTC Authorization form and bring it (and the medication) to your child’s school clinic. Please plan to spend a few minutes with the nurse or secretary checking in the medication – all medication must be counted, documented, and signed in by a staff member and the parent (if possible). *Review medication forms for specifics about proper container, labeling, etc.
Can I send medication to school with my child?
No. An adult must bring medications to school and pick medications up from school. The exceptions to this are Epi-pens and inhalers, and some diabetic supplies, with parent and doctor permission to self carry (signatures required on Medication Authorization form).
Can my student have cough drops?
An OTC Authorization form needs to be filled out for cough drops. Determination as to if the child may self-carry the cough drops, or if they need to be left in the clinic, will be made on a case-by-case basis.
What do I need to do if my child needs medication during field trips that extend beyond school hours, or overnight?
If it is a prescription medication, you must have a Prescription Medication Authorization form filled out and signed by your child’s doctor, and signed by a parent/guardian. If it is an over-the-counter medication, the parent/guardian may fill out and sign the OTC Field Trip Medication form. Please provide the completed form/s and only the needed amount of medication to the clinic at least a week prior to the field trip date.
What happens to my child’s left-over medication at the end of the school year?
A reminder letter to pick up any left-over medication will be sent home at the end of each school year. Medications not picked up will be disposed of prior to the start of the next school year.
Who will give my child their medication?
Each school clinic has a nurse who will, in most cases, be administering daily and as-needed medications. However, according to WCSD School Board policy, medication can be administered by the School Nurse, School Health Associate, Secretary, Principal, Teacher, or any employee designated in the student’s IEP.  Some special circumstances may occur, such as a young child who cannot self-administer an insulin injection – this will be administered by a nurse.
What happens if there is a change is my child’s medication?
For prescription medication, a new Prescription Medication Authorization form must be filled out/signed and returned to school with the new medication.  For OTC medication, a new OTC Medication Authorization form must be filled out/signed and returned to school with the new medication. If a medication is being discontinued, the parent may notify the nurse that the medication has been stopped, and pick up any remaining medication from the school clinic.
Do I have to fill out new paperwork every year?
Yes. New paperwork must be completed and turned in at the beginning of every school year.
What is the procedure (for students with medication needs) for the beginning of the school year? New medication paperwork and medication should be brought to the school clinic prior to the first day of school.
Who can sign medication authorization forms?
A parent or legal guardian can sign the forms.
Eating and Feeding Evaluation: Children with Special Needs form (to be completed by physician and parent)
Food Allergy & Anaphylaxis Emergency Care Plan (to be completed by physician and parent)
Food Allergy Guidelines
What do I need to do, for school, if my child has a food allergy?
Please notify the nurse and your child’s teacher of any food allergies. Also, provide doctor documentation and any medical orders (i.e., medication for allergic reaction), if applicable.
What accommodations are made for my child with a food allergy?
Per our Food Services Supervisor, “physician ordered accommodations/substitutions are only made for children with severe life threatening allergies. However, we always have double fruits and vegetables available to students and adults when requested.”
Pre-School/Kindergarten Immunization Statement
Grades 1-12 Immunization Statement
7th Grade Immunization Letter (Tdap requirement)
When are immunization records due?
Documentation of immunizations required for school enrollment must be received by the school within 14 days of enrollment. If proof of immunization hasn’t been provided by that time, your child may be excluded from school starting on the 15th day, and may not return until proper documentation has been received.
What do I do if I don’t want my child immunized?
Please provide your nurse with a letter stating that you have chosen not to immunize (and which immunizations not received) and the reason why (i.e., medical reasons, religious beliefs, personal beliefs), along with the date and your signature. **Please note: if there is an outbreak of an illness in your child’s school that your child has not been immunized against, your child may be excluded from attending school until the outbreak is over.
Where can I get immunizations for my child?
You can get immunizations from your child’s doctor or from the local health department (Public Health - Dayton & Montgomery County). For more information on immunizations through the health department or for questions, please call the PHDMC Immunization Clinic at (937) 225-4550.
What do I do if I can’t afford immunizations?
You can contact Public Health – Dayton & Montgomery County Immunization Clinic at (937) 225-4550 to get information on cost, making an appointment, etc.  Be sure to ask them what you need to bring with you when you go for an appointment.
Home Instruction Parent form
Home Instruction Physician form
What is Home Instruction?
Home instruction is tutoring (1 hour per day of school missed) that may be provided for students who can’t attend school due to a medical (or other) reason for at least 10 consecutive days.
How can my child qualify for Home Instruction?
Parent/guardian must fill out the Home Instruction Parent form, and the treating doctor must fill out the Home Instruction Physician form. Turn these forms in (ASAP) to the nurse, who will then review the forms to see if the student meets Home Instruction requirements.
Who will tutor my child, while he/she is receiving Home Instruction? Usually a teacher in your child’s school will provide tutoring. However, a teacher from another school in our school district may provide the tutoring.
Where does tutoring take place?
Arrangements for times and locations of tutoring sessions will be made between the parent and the tutor. If necessary, tutoring may occur in your home, but only when a parent is present.
Who do I call if I have questions about Home Instruction? You can call the nurse, School Psychologist, or your child’s School Counselor for more information.
Emergency Medical Form
Do I need to turn in a new Emergency Medical Form every school year?
Yes, a new EMF is required at the beginning of every school year. The information on this form is used to update the parent/guardian/emergency contact information in our computers yearly.  A copy of the EMF is also sent with your child in the event of an emergency to the hospital. The EMFs are also taken on field trips in the case of an illness or injury while out of the school building.
What if my information changes after I have turned in my child’s Emergency Medical Form?
Please notify the clinic or a secretary at your child’s school with updated information as needed. If you have moved, please provide appropriate proof of residency to your child’s school. If there are updated custody issues, please provide appropriate custody court documents to your child’s school.
Who is my child allowed to be released from school to?
Your child will be allowed to be released from school to those listed on his/her EMF. Please be sure to tell whoever is picking up your child to bring a picture ID.
Release of Medical Information form
Why do I need to sign a medical release of information?
This allows sharing of important information between necessary school staff and your doctor, counselor, etc., providing outside care to your child. Being able to work together with outside sources helps us provide better care to your child while at school and also helps minimize school days missed due to medical (or other) issues.
District Head Lice Guidelines
Ohio Department of Health pamphlet
Head Lice letter
Nit Notification
What do I do if my child has head lice?
Please notify the school and provide the date and treatment that was done and the date treatment follow-up is to occur.
Where did my child get head lice?
Lice are passed from direct personal contact. This can occur when there is head-to-head contact or when sharing combs, hats, or coats. It also can occur during sleepovers, sitting in seats with cloth covering (i.e., movie theaters, car seats, etc.), or any other event where there may be direct contact or sharing of items.
How do I get rid of head lice?
Use a lice-killing treatment to kill the live bugs. Nits (eggs) must be removed manually, either by using your fingernails or a metal lice comb. Wash all bedding, towels, and recently worn clothes in hot water and dry in a hot dryer for at least 20 minutes. Items that can’t be washed but can go in the dryer, can be dried on high heat for at least 20 minutes. Items such as stuffed animals (things that can’t be washed or dried) can be dry-cleaned or sealed in a plastic bag for 2 weeks. Also, be sure to vacuum upholstered furniture, rugs, and car seats. Soak brushes and combs in hot water for 10 minutes. *Make sure to check everyone in the household, and treat them if lice are found.
How do I prevent my child from getting head lice?
Teach your child not to share items that may transfer lice (include not trying on hats/scarves in stores, etc.). Talk to the parents of your child’s friends to ensure you are all doing your best to prevent lice from spreading.
District Bed Bug Guidelines
Ohio Department of Health Bed Bug pamphlet
Parent Letter
What happens if a bed bug is found on my child at school?
Your child will discreetly be removed from the classroom. Their clothing, coat, book bag, etc., will be inspected for bed bugs and their arms, legs and face will be inspected for insect bites. Their belongings will be placed in a plastic bag and sealed until the end of the school day. If their coat is needed for recess and/or dismissal, it will be put in the dryer for at least 20 minutes, and then returned to the student. The parent/guardian will be notified, and a bed bug notification letter will be sent home.
What screenings may be conducted at school?
Your child may receive a hearing, vision, and/or dental screening.
Why does my child need a hearing/vision (or possibly dental) screening?
School hearing and vision screenings are required by law. Vision screenings are done on all PreK, K, 1st, 3rd, 5th, 7th, and 9th grade students. Hearing screenings are done on all PreK, K, 1st, 3rd, 5th, 9th and 11th grade students. Dental screenings are done on all 2nd grade students (and possibly PreK and K). Other children who will be screened include those due for IEP re-evaluations, students who are referred by a teacher/staff member, or those requested by a parent or student. Screenings may help to keep children healthy, find potential problems early, and decrease absences from school.
What if I don’t want my child screened?
Please provide your request, in writing, to the nurse at the beginning of every school year. Make sure the request includes your child’s name and the date.
Who does the screenings?
The majority of the screenings are done by the nurse or supervised dental hygienist students, or a local dentist, who is volunteering his/her time.
Are screenings the same as an exam?
No.  Screenings are a basic means of determining potential problems. Please talk to your child’s doctor if you feel they are having any vision/hearing/dental issues.
Pre-School Physical form
Pre-School Dental form
When are Pre-School physical and dental forms due?
Completed forms are required for enrollment into preschool, and then must be renewed every 12 months, while in preschool.
Urinary Catheterization procedure order form
Tube Feed procedure order form
Other Medical procedure order form
What if my child needs a special medical procedure during the school day?
If your child requires a medical procedure (i.e., urinary catheterization, tube feed, etc.) during the school day, please contact your nurse immediately. A doctor’s order will be required. You will also need to provide the school with supplies necessary to perform the ordered medical procedure.
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430 E. Pease Avenue   West Carrollton, OH 45449      Telephone: (937) 859-5121   Fax: (937) 859-5250
Email Contact: Tammy Pierce School CMS created by eSchoolView