Medication Authorization Form

Whenever possible, children should be given needed medication by their parents at home. Littleton Public Schools encourages parents to work with their doctors to prescribe dosages that can be given at home rather than at school.

However, if children must receive medication during the school day, it must be given by a registered nurse or someone under the direction and supervision of the nurse. The State Board of Nursing requires certain procedures to be adhered to when a child must take medication at school, whether it is prescription or nonprescription medication.

• Elementary and middle level students may not carry and self-administer their own medications unless authorized in writing to do so by the physician, and their parents have submitted a written request to the school principal. The school nurse must concur that the child can safely self-administer his/her own medications.
• The school must have a signed parent permission statement that clearly states the name of the medication and the exact time it is to be administered at school.
• The school must also have a physician’s signed statement, which matches instructions on the medicine container, and the signed parent permission statement. This requirement applies to both prescription and nonprescription medications. This statement should also include the purpose of the medication, the length of time it needs to be administered at school, and the possible side effects.
• Prescription medication must be in its original pharmacy labeled container, which clearly shows the name of the prescribing physician, the child’s name, the name of the medication, the time it is to be administered, and the dosage. Nonprescription medications must also be in their original container.
• Parents are responsible for bringing the child’s medication to the school.
• Dosages, which require a tablet or pill to be split, must be split by the pharmacist. School staff may not split tablets or pills.
• If the dosage requirement changes, a new permission form must be completed and the medication container label must match the new instructions.  

Medication Authorization Form (Spanish)