Parents/guardians of students requesting medications to be administered by Adventures Plus Staff are required to provide the following:
- The medical providers orders/action plan for medication(s). Orders/notes must have a written or electronic signature by the medical provider. Action plans and orders must be updated annually.
- The Adventures Plus parental release/authorization (at the end of this form)
- The medication supplied in the original bottle and pharmacy label. The bottle must have expiration date clearly on the label. (**Ask the pharmacist to divide the medication into 2 bottles with complete labels, one for school and one for home.)
- Your student must have taken this medication previously due to possible adverse reactions. (With the exception of epi-pens.)
Approved Over-the-counter Medications: If the medication is on the list below, a medical provider order/note is not required. The medication must be in the original container and must have the dosing information and expiration date clearly printed on the bottle and/or box of the medication. A+ will administer the appropriate dose as labeled on the box, if you request a different dose to be given, a provider note/orders must be submitted. Please label over-the-counter medications with the students first and last name.
- Tylenol (acetaminophen)
- Motrin (Ibuprofen)
- Benadryl (Diphenhydramine)
- Zyrtec (Cetirizine)
- Lactaid (lactase enzyme)
- Artificial Tears (Normal Saline Eyedrops)
IMPORTANT NOTE: Adventures Plus does NOT have access to medications in the school health office. Adventures Plus will need their own supply.
If you have any questions, please reach out to the Adventures Plus RN.
Laura Bautch
laura.bautch@ahschools.us
(763) 506-1424
PLEASE PROCEED TO FILL OUT THE REQUEST FORM:
To fill out this form you will need:
- Current medical provider orders (if providing prescription medication) preferably in a pdf
- Medical providers contact information
- Optional: (but greatly appreciated) clear picture of the student. (We use pictures to label medication boxes and their information in the health binder)
