Medication Consent Form OLMC
All prescription medications must be given to the school nurse during Meet the Teacher. Medication should be in the original container with pharmacy label attached. Medications must be picked up at the end of the school year. If they are not picked up within the week following the last day of school, they will be disposed of according to Diocesan standards. 

The form must be filled out once for each medication to be administered.
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Email *
Student First Name *
Student Last Name *
Student Date of Birth *
Parent First Name *
Parent Last Name *

I hereby request and give my consent for the school nurse or person designated by the administrator to see that my child receives their prescribed medication


*
Medication Name *
Route of Administration *
Required
Dosage to be Administered *
Time of Administration *
Expected Duration of Treatment *
Example: 20256-2027 school year
Prescribing Physicians Name *
Physician's name must be on medication label. 
Reason for Medication *
Would you like medication administered on half days? *
Required
A copy of your responses will be emailed to the address you provided.
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