Medication Forms

• ANY MEDICATION

  (Over-the-Counter, prescription medication or products) including:

  • OTC - pain reliever, topical lotion, ointment, throat lozenges, eye drops, vitamins, supplements etc. or
  • Any prescription medication

  *For Inhalers OR Anaphylaxis meds see below

1. Parent-Physician Medication Release signed by parents and Medical Doctor

2.    All medications must be signed in to the health office by parents in the original container.

3.    Prescription medications require the current prescription label.

4.    If doctor signs non-Rocklin Academy form (ex: Kaiser form), then parents still need to sign the front page of Rocklin Academy Parent-Physician medication release

5. General Medications cannot be carried by a student. Only rescue meds can be carried by a student with MD approval.

● Inhaler / Asthma Medication*

1.      Asthma Action Plan signed by parents and Medical Doctor

2.     If doctor signs non-Rocklin Academy form (ex: Kaiser form), parents still need to sign first page of Rocklin Academy Parent-Physician medication release.

 3.       Self Carry Medical Release

* If student self carries, then it must be indicated by the MD on the Asthma Action Plan and student and parent need to complete self-carry contract.

• ·     Epinephrine / Benadryl

1.      RAFOS Anaphylaxis Action Plan signed by parents and Medical Doctor

2.  If doctor signs non-Rocklin Academy Form (ex: Kaiser form), parents still need to sign first page of the Rocklin Academy Parent-Physician medication release.

For Field Trips:

All of the above required documentation must be turned into the school office no less than two weeks prior to the field trip.

Rescue Meds that can be carried by a student: 

·    The paperwork is signed and complete

·   Prescription label is included

·    Medication is in the original container

·    Medication is current (not expired)

·    Delivered by a parent, guardian or designated adult

·    Medication matches doctor’s orders