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Permission for Self-Administration of Medication in School
Per District Policy 5330 & Regulation 5330, District-wide form for permission for self-administration of medication for a potentially life-threatening illness.
For students 7 - 12, in addition to an action plan submitted (for Anaphylaxis, Asthma, and/or Seizures), please also include the "Permission for Self-Administration of Medication in School" for all inhalers and epipens. If unable to self-carry, please reach out to your building nurse. Note: Students who participate in school sports and clubs will need to be able to self-administer their emergency medication.