Hillsboro Independent School District

Medication Administration Policy

 

Dear Parent/Guardian:

Your child may have an illness that requires medication for relief or cure that does not prevent him or her from attending school. When possible, such medications should be scheduled to be taken at home. However, according to Texas State

Legislature and Hillsboro ISD Board of Trustee policy, a medication may be dispensed to a student by school personnel with parental consent. The following requirements must be met by the parent or legal guardian requesting this service:

1) All prescription medications must be in the original pharmacy container and labeled by the pharmacist. The label must include:

a) Student’s Name

b) Name of prescribing health care provider

c) Name of medication

d) Amount of medication to be given and frequency of administration

e) Date prescription filled

f) Expiration date

 

2) All non-prescription medications must be in their original containers or blister packs. The medication cannot be expired according to the expiration date on the container.

3) All prescription and non-prescription medications to be administered at school must be accompanied by a written request, with the following information:

a) Student’s name

b) Name of medication

c) Amount of medication to be administered

d) When / how often the medication is to be given

e) Date to start administration

f) Expiration date of medication

g) Signature of physician only if it is an over-the-counter medication to be given on a routine basis

h) Signature of parent/guardian

Permission forms are available at the school office or on the Hillsboro ISD website www.hillsboroisd.org

4) Medications prescribed or requested to be given three times per day or less are not to be given at school unless a specific time during school hours is prescribed by a health care provider, or the school nurse determines that a special need exists for an individual student.

5) All medications will be stored and dispensed in the school clinic.

6) No student may have prescription or non-prescription medications (including cough drops) in his/her possession on school grounds during school hours without proper authorization. Parents must bring the medication in to the school and pick it up as needed.

7) According to the Texas Department of Health, parental permission is considered good until the end of the school year unless permission is revoked in writing, or the medication is no longer available for use.

8) In accordance with the Board of Nurse Examiner’s rule, 22 Texas Administrative code 217.11, the school nurse has the responsibility and authority to refuse to administer medications that, in his or her judgment, are not in the best interest of the student.

9) The nurse will be the designated school official responsible for the administration of medications. If the nurse if absent or unavailable, the responsibility for medication administration falls to one of three authorized school personnel trained in medication administration. A parent/guardian has the right, in writing, to decline allowing this alternate person from administering medication to their child. In such a case, it is the parent’s responsibility to come to the school and administer the medication.

10) Hillsboro ISD is not responsible for supplying medications to the students, including pain relievers and antibiotic ointment. Any medication a parent wishes for their child to have available for their use for the school year can be brought to the nurse, stored, and used until the end of the school year, until the medication expires, or until the parent takes the medication back home.

11) Any medication not picked up by the end of the school year will be destroyed.

Hillsboro Independent School District Student Health Services

STUDENT ENROLLMENT HEALTH HISTORY

 

Student’s Full Name_______________________________ Date of Birth________________ Gender______ Grade_______

Name of Parent(s) or Guardian(s):_________________________________________________________________________

This information will be utilized by the school nurse to develop a health plan for your child if necessary. Information regarding

your child’s health condition will be shared only with staff who need to know to assist your child in school.

Who is your child’s primary doctor?_______________________ City__________________ Phone_____________________

Does your child see a specialist for any reason? Yes No

If yes, for what reason is your child being seen?________________________________________________________

Specialist’s name _______________________________ City__________________ Phone _____________________

Does your child have:

ADD/ADHD   Yes No  Specify___________________________________________

Tourette Syndrome Yes No Specify___________________________________________

Bipolar Yes No Specify___________________________________________

Other psychological condition Yes No Specify___________________________________________

Epilepsy or seizures Yes No Specify___________________________________________

Other neurological condition Yes No Specify___________________________________________

Allergies to Yes No Specify___________________________________________

food, medicine, insects, Type of reaction___________________________________

or environmental triggers Emergency medication______________________________

Asthma Yes No Specify___________________________________________

Diabetes Yes No Insulin Yes No

Frequent ear infections Yes No Specify___________________________________________

Headaches/migraines Yes No Specify___________________________________________

Heart condition Yes No Specify___________________________________________

Orthopedic (bone/joint) or musculoskeletal

condition Yes No Specify___________________________________________

Kidney or bladder condition Yes No Specify___________________________________________

Bowel problems (ex. constipation, diarrhea) Yes No Specify___________________________________________

Gastric reflux/heartburn Yes No Specify___________________________________________

Skin condition (ex. eczema, psoriasis) Yes No Specify___________________________________________

A birthmark Yes No Specify___________________________________________

History of surgery Yes No Specify___________________________________________

Hearing or vision problem Yes No Specify___________________________________________

Hearing device Specify_____________________________________

Glasses Contacts

 

Other condition not specified Yes No Specify___________________________________________

Does your child:

Take daily medication Yes No Specify___________________________________________

Take emergency medication Yes No Specify___________________________________________

Additional information regarding medical conditions/surgeries:______________________ ____________________________

_____________________________________________________________________________________________________

Please notify the school as soon as possible to inform us of any changes to this information. If your child has a medical

condition that needs an individual health plan formulated, you will be contacted.

My signature indicates that the above information is complete and true to the best of my knowledge.

Parent or Guardian Signature____________________________________________________ Date_____________________

Servicios Médicos del Estudiante de la Hillsboro Independent School District

HISTORIA DE LA SALUD DE LA INSCRIPCIÓN DEL ESTUDIANTE

Nombre del estudiante _____________________________________ Fecha de nacimiento ____________ Género ______

Grado______ Nombre de padres o del guarda:_____________________________________________________________

Esta información será utilizada por la enfermera de la escuela para desarrollar un plan de la salud para su niño en caso de

necesidad. La información con respecto a su condición de la salud de niño será compartida solamente con el personal que

necesita conocer para asistir a su niño en escuela.

¿Quién es doctor primario de su niño?____________________ Ciudad_______________ Teléfono__________________

¿Su niño ve a especialista por razón? Sí No

¿Si sí, porque qué razón están viendo su niño? _____________________________________________________

Nombre de especialista_________________________ Ciudad___________________ Teléfono ______________

Hace a su niño tienen:

Desorden de déficit de atención Sí No Especifique ____________________________________

Bipolar Sí No Especifique ____________________________________

Síndrome de Tourette Sí No Especifique ____________________________________

El otro condición psicológica Sí No Especifique ____________________________________

Epilepsia o asimientos Sí No Especifique ____________________________________

El otro condición neurológico Sí No Especifique ____________________________________

Alergias a Sí No Especifique ____________________________________

alimento, medicina, insectos, Tipo de reacción _______________________________

o disparadores ambientales Medicación de la emergencia _____________________

Asma Sí No Especifique ____________________________________

Diabetes Sí No Insulina Sí No

Infecciones frecuentes del oído Sí No Especifique ____________________________________

Dolores de cabeza/jaquecas Sí No Especifique ____________________________________

Condición del corazón Sí No Especifique ____________________________________

Condición de la ortopédica (hueso) o

musculoesquelética Sí No Especifique ____________________________________

Problemas con los riñones o la vejiga Sí No Especifique ____________________________________

Problemas con los intestinos Sí No Especifique ____________________________________

Reflujo gástrico/acidez estomacal Sí No Especifique ____________________________________

Condición de la piel (ex. eczema, psoriasis) Sí No Especifique ____________________________________

Marca del nacimiento Sí No Especifique ____________________________________

Historia de la cirugía Sí No Especifique ____________________________________

Audiencia o problema de la visión Sí No Especifique ____________________________________

Dispositivo de la audiencia Especifique______________________

Antiojos Contactos

 

La otra condición no especificada Sí No Especifique ____________________________________

Hace a su niño:

Toma medicación de la emergencia Sí No Especifique ____________________________________

Toma medicación diaria Sí No Especifique ____________________________________

Información adicional con respecto problemas médicos/a cirugías:_____________________________________________

__________________________________________________________________________________________________

Notifique por favor la escuela lo más pronto posible para informarnos de cualquier cambio a esta información. Si su niño

tiene una condición médica que necesite un plan individual de la salud formulado, le entrarán en contacto con usted.

Mi firma indica que la información antedicha es verdad al mejor de mi conocimiento.

Firma del padre o del guardián _______________________________________________ Fecha____________________

Texas School & Child-Care Facility Immunization

Texas Health & Human Services

Vaccine Preventable Diseases