Dear Parents, Guardians, and Medical Providers,
School Health offices are limited by state regulations and can offer only a minimal amount of services to our students without a Medical Provider’s Order and Parent/Guardian signed permission. If you would like for your student to receive any of the following while in school please check the box next to the medical order, have their medical provider sign, and parent/guardian sign. (Your child cannot receive any of these listed items without this form being completed.)
Thank you for your understanding and cooperation!
Gloria Neuroth, RN, BSN
Here is a list of medications that will need this form filled out:
- Apply Aquaphor Healing Ointment topically to dry skin as needed.
- Apply Biofreeze topically to areas with musculoskeletal pain as needed.
- Apply Antibiotic Ointment topically to open or healing skin as needed.
- Apply Hydrocortisone Cream 1% to red, irritated, or itchy skin as needed.
- Apply Water Jel Cool Jel topically to burns as needed.
- Apply Water Jel Burn Dressings topically to burns as needed.
- Apply Orajel to areas causing oral pain as needed.
- Administer cough drops by mouth for sore throat or cough as needed.