Request for Self-Administration of Anaphylactic Medication 7.270 F4

Board of Education policy permits students who have been diagnosed with severe allergic (anaphylactic) reaction and prescribed medication be permitted to carry and administer the medication independently. Documentation from the parent and physician certifying that the student has been instructed in the use and self-administration of the medication allergy or allergies medication must be on file at the school.

This form must be completed, signed by the parent and physician / doctor, and submitted to the school office on an annual basis, at the beginning of each school year.

Request for Self-Administration of Anaphylactic Medication 7.270 F4