Prescription is not required for administration of over the counter painkillers - see below. 

If the medication is for asthma, I have provided an asthma action plan. I understand that it is recommended the asthma action plan be signed by a healthcare provider. 

If the medication is for diabetes, I have submitted a signed physician diabetes care plan. 

When reasonably possible, a member of the school staff will observe self-administration of medication. It is understood that, while highly desirable, circumstances limit the capacity of school staff to observe self administration of medication. However, staff members are to observe self-administration of diabetes medication. 

Over the Counter Painkillers:
When circumstances support self-carry and self-administration of over the counter painkillers during school hours, the parent or guardian submits form: Self-Administration and Self Carry of Medication During School Hours. Aspirin, in rare instances, triggers Reye's syndrome. As a precaution, the school does not allow self-carry and self-administration of aspirin. 

Students are, upon submission of a note to the teacher, allowed to self-administer and self-carry cough drops/throat lozenges. 

I understand that Saint Luke Academy and its personnel incur no liability (except for willful and wanton conduct) as a result of injury incurred when the designated medication is administered.

This form and information must be renewed and updated every year.