Medication (Non-Prescription)
Non-prescription medication (over-the-counter) which is FDA approved can be administered. The Non-Prescription Medication Authorization Form must be on file at school authorizing school personnel to administer (Form 5141.6a)

Non-prescription drugs must come to school in the original manufacturer's packaging with ingredients and recommended therapeutic dose.

Non-prescription medications must be supplied by parent/guardian in the original container with the student's name affixed.

Any non-prescription medication intended for long-term use on a daily basis must be accompanied by a practitioner's signature.

All medication must be supplied by the parent/guardian.

Christ the Lord School Personnel will notify the parent/guardian when medication is administered.

Student name
first and last name
Your answer
Student date of birth
month / day / year
Your answer
Student grade *
Medication
Medication name, dose, route frequency, time/conditions, duration
Your answer
Reason for medication
(ex: allergies, cold, migraines, headaches, tooth pain, etc.)
Your answer
When to administer
(ex: every day, as needed)
Your answer
Specific side effects or considerations
(ex: watch for a rash, keep child calm, etc.)
Your answer
Do you have more children to include?
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