Susan Chilton
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Allergy Action Plan Forms
If your child has a life threatening food , insect , or environmental allergy, please contact the clinic so that we, along with your child's physician, can develop a plan to keep your child safe and healthy at school. You may download these forms to take to the Dr and return them to the school nurse , along with any medication that is needed.

Medication Authorization Form
A)If your child has a need for medication at school, it must be given in the clinic. If it is an over the counter medication(non prescription), it may be brought to the clinic by your student, along with a note from you, stating the: of the medication of the student
3.dosage to be given
4.time to be given
The medication must be in the original container and not be expired. Dosages must be given only as directed on the label, according to your child's AGE(not weight) , per district policy. No herbal medications or supplements may be given by the school nurse- only FDA approved medications. Over the counter medications can be administered by /kept in the clinic for up to two weeks without a Dr order, but if they are to be given at school after that time, a Dr note is required.

B) Prescription medications MUST BE BROUGHT IN BY THE PARENT or another designated adult. They must include the prescription label and must be given as stated(dosage, time, and amount) on the label. These include ADHD meds, inhalers, epi pens, antibiotics, and other prescription medications. Narcotics may not be administered at school. If you have any questions, or concerns, please contact the clinic:
Please use the form provided below, if possible, to send with all medication.

Permission to carry asthma inhaler
If your child's physician has determined that it is medically necessary for your child to carry his/her asthma inhaler while at school for quick access, the attached form must be completed by the Dr and the inhaler must be brought in by the parent the first time it is brought to school. The student will be provided with a copy of this form which must be kept with the inhaler, in his/her possession at all times. Please contact the clinic for any questions. If your student is in athletics at Doerre and you feel that they may need access to their inhaler during after school hours, please contact the clinic and your student's coach.