2021-22 BHS Over the Counter Medication Consent

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Please submit this form indicating whether or not you give consent for your child to receive OTC medications from the BHS school nurse.

Email *

Student Last Name *

Student First Name *

Authorization For Medical Administration

Written permission must be received from the parent/guardian in order for a child to receive medicine at school. Listed below are over-the-counter medications that our school keeps in stock for administration to students. Licensed school nurses will supervise administration of medications. All medications will be given according to label directions on the container. Indication(s) for the administration of medicine will be determined on an individual basis. This authorization is valid ONLY for the school year indicated on the date this form is signed.
--Acetaminophen/Ibuprofen (regular strength) WILL NOT BE GIVEN BEFORE 10:00am OR AFTER 2:00pm. *may be given for fever over 102 degrees and headaches and/or other pains not relieved by other means such as ice, heat, food, rest, etc.
--Antacid WILL NOT BE GIVEN BEFORE 10:00am OR AFTER 2:00pm
--Caladryl
--Cough Drops
--Sore throat spray
--Oral pain reliever (Ora-jel)
--Diphenhydramine hydrochloride - given in case of allergic reaction (indication for administration to be determined by the school nurse)
--Antibiotic Ointment/Benadryl Cream/Hydrocortisone Cream

Do you give permission for your child to receive the above named medicines from the school? *

Yes

Parent/Guardian Electronic Signature *

A copy of your responses will be emailed to the address you provided.

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