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Dear Parent/Guardian:
ln order for us to legally administer medication to your child at school during school hours, the
school must have on file a request signed by the physician and the parent. This is for all
medications (i.e.: Tylenol, aspirin, cough syrup, cough drops, antibiotics, etc.)This request must be filed each new schoolyear. Medication must be delivered to the school by the parent or guardian (not the student) in the
container dispensed by the pharmacy and the inforrnation on the label must be the same as the
physician's order. The medication bottle or box (inhaler box) must be labeled with the name of
the student, the name of the medication, the dose to be taken and the time intervals.Request for Medication to be Administered During School Hours
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Medical Exemptions A temporary or permanent medical exemption to one or more of the immunizations may be granted under certain circumstances if a licensed physician (M.D. or D.O.) provides a written statement which states: That the physical condition or medical circumstances of the child are such that the required immunization(s) is not indicated. Which vaccines are being exempted. Whether the medical exemption is permanent or temporary. The expiration date, if the exemption is temporary. This is also discussed at www.ShotsforSchool.org under exemptions. The physician’s written statement must be added to the student’s cumulative folder along with the Blue Card. Students with temporary medical exemptions (page 10) must be tracked to confirm that either they have received exempted doses before the exemption expires or that a temporary exemption has been extended by a licensed physician.
