SY 24-25 Over-The-Counter Consent

St. Louis Children’s Hospital Healthy Kids School Nurse Program Over-the-Counter Standing Orders - Valid 2024-25 School Year

 

PARENT PERMISSION FOR THE ADMINISTRATION OF OVER-THE-COUNTER MEDICATION

Listed below are nonprescription medications that the nurses can give to students only with parent permission. We hope that using these medications, as needed, will reduce both absenteeism and student discomfort while in school. If a student needs routine medications, other arrangements should be made. Medications will be given in age/weight appropriate doses. You will be informed if nonprescription medications are given to your child.

Please fill out this form, giving your permission for your child to get these medications if needed. It will become a part of his or her health file. If you do not want a certain medication given to your child, check the name of the medication on the list below. No nonprescription medications will be given to students whose parents do not complete and return this form.



OTC Medications List
Child's Name
Select date MM slash DD slash YYYY
Please enter a number from 4 to 15.
Name of Parent or Guardian Signing This Form(Required)

As the parent or legal guardian of the above named child, I give permission for the school nurses/nurse practitioner/physician to give the above named nonprescription medications to my child for the conditions indicated (except for any that I have checked). This will be effective for the 2024-25 school year.

Clear Signature
Select date MM slash DD slash YYYY

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