Medication Administration Authorization

Official school form

Required only if your child needs prescription or over-the-counter medication during the school day.

Rules for medication at school

All medication must arrive in its original, labeled container and be delivered to the office by an adult — never in a student's backpack.

Prescription medication must be labeled with the student's name, medication, dose, and schedule. Over-the-counter medication requires written parent instructions.

Students may self-carry rescue inhalers or epinephrine auto-injectors when a parent authorizes it below.

Unused medication must be picked up by a parent; it will not be sent home with a student.

Information to complete

Student full name *

Student date of birth *

Medication name *

Dose and route *

Time(s) / conditions for administration *

Start and end dates

Prescribing provider & phone

Possible side effects staff should watch for

I authorize my student to self-carry and self-administer this medication (inhaler / epinephrine only).

Yes

I request and authorize school staff to administer the medication described above according to these instructions.

Parent / guardian signature

Date

Solomon Heights Academy3200 NW 48th Street, Oklahoma City, Oklahoma 73112Medication Administration Authorization

Return completed forms to the school office at 3200 NW 48th Street, Oklahoma City, Oklahoma 73112.