• The following are a list of medical forms to be completed by a parent/guardian, please note that some forms require a physician's signature. All students who have a medical condition should complete a student individual emergency medical plan. Additional forms are required for special diets (i.e. no pork, soy allergy, etc.), diabetes, siezures, severe allergies, and asthma. Medication forms must be completed on all prescribed and OTC (over-the-counter) medications in order for the nurse to administer the medication to your child. Please note that students are not allowed to carry medications on campus. Exceptions are those who have completed the self carry medication form. Any student found to have medications in their possession will be sent to the nurse's office and a parent or guardian will be notified. Please refer to the student handbook in regards to medications on campus. If you have any questions or concerns please feel free to contact me by email at 

    Student Individual Emergency Medical Plan (all students with a medical condition) Requires a physician's signature

    Parent Authorization Release of Information

    Anaphylaxis-Emergency Plan Requires a physician's signature

    Diabetes Requires a physician's signature

    Asthma Requires a physician's signature

    Medication Form (prescribed and over the counter) Requires a physician's signature

    MAR Log (medication administration record)


    Severe Allergy History Form 

    Special Diet Accommodations Form 20'-21' Requires a physician's signature



    Medication at School

     Any medication, prescription or over the counter, is furnished by the parent/guardian and brought to the nurse by an adult.

    • If it is prescription, it must be in its original pharmacy bottle (pharmacies will provide a second container specifically for school), labeled with the child’s name, prescription number, and identification and instructions of medication.

    • If it is an over-the-counter medication, it is in its original container also and has been labeled legibly with the child’s name.

    • If the medication is a sample given by the physician, please provide a signed note from the physician telling who the medication if for, the date, and instructions for use.

    • The specific directions for administration such as, date, time and amount to be given, for any of these items must be entered onto the consent for administration form and signed by the parent/guardian.

    • School district personnel will not be responsible or liable for any reaction to medicines given according to those directions.

    • All medication will be kept in a locked cabinet in the nurse’s office and dispensed from there.

    • In the Deer Valley school district, Tums, cough drops and ointments/creams such as Neosporin, are considered medications and need to be kept in the nurse’s office also with a consent form signed.

    • It is the parent responsibility to monitor medication supply and provide additional medication when needed.

    At the end of the need for the medication, any remaining medication needs to be picked up or it will be destroyed within 3 days. Year round medications not picked up within 1 day of the end of the school year will also be destroyed if not picked up by an adult. If these district wide rules are not followed your child/student may be subject to Drug Paraphernalia Possession consequences.

    Parents please feel free to bring in “as needed” medications, such as cough drops and Tylenol, to keep on hand for your child if you so desire.