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Nursing Services Self-Medicating and Self-Monitoring

1. Ensure that that the Self Medicate form is completed with the following:  name of the medication/procedure; dosage, time, and route of the medication; statement from the legal prescriber that the student may self-medicate and monitor; signature of legal prescriber; signature of parent or legal guardian.
2. An individualized health management plan (IHP) has been developed by the school nurse with input from the student’s healthcare provider, the parent, and the student.
3. Documentation has been received from the student’s healthcare provider stating that the student has been trained and is competent to self-medicate and/or self-monitor.
4. Signed release of information from the parent allowing sharing of information to those school employees with a legitimate need to know has been received.
5. Medication is provided in an appropriately labeled prescription container.
6. The school has determined that the student’s self administration/monitoring will not jeopardize the safety of the student or others.
7. The Parent Permission form must be initialed and signed by the parent and provided to the school nurse.  This form acknowledges that the School District shall incur no liability as a result of any injury arising from the student self-medicating and/or monitoring.  The parent/legal guardian shall indemnify and hold harmless the district and its employees and agents against any claims arising out of the student self-medicating and/or monitoring.
8. The Student Agreement form must be initialed and signed by the student and provided to the school nurse.