507.2 - Administration of Medication to Students

The board is committed to the inclusion of all students in the education program and recognizes that some students may need prescription and nonprescription medication to participate in their educational program.

Medication shall be administered when the student's parent or guardian (hereafter "parent") provides a signed and dated written statement requesting medication administration and the medication is in the original, labeled container, either as dispensed or in the manufacturer's container.

When administration of the medication requires ongoing professional health judgment, an individual health plan shall be developed by licensed health personnel working under the auspice of the school with collaboration from the parent or guardian, individual’s health care provider or education team pursuant to 281.14.2(256). Students who have demonstrated competence in administering their own medications may self-administer their medication. A written statement by the student's parent shall be on file requesting co-administration of medication, when competence has been demonstrated. By law, students with asthma or other airway constricting diseases or students at risk of anaphylaxis who use epinephrine auto-injectors may self-administer their medication upon approval of their parents and prescribing physician regardless of competency.

Persons administering medication shall include the licensed registered nurse and physician,and persons to whom authorized practitioners have delegated the administration of medication (who have successfully completed a medication administration course). The medication administration course is completed every five years with an annual procedural skills check completed with a registered nurse or a pharmacist. A record of course completion shall be maintained by the school.

A written medication administration record shall be on file including:

• date;

• student’s name;

• prescriber or person authorizing administration;

• medication;

• medication dosage;

• administration time;

• administration method;

• signature and title of the person administering medication; and

• any unusual circumstances, actions, or omissions.

Medication shall be stored in a secured area unless an alternate provision is documented. Emergency protocols for medication-related reactions shall be posted. Medication information shall be confidential information.

Disposal of unused, discontinued/recalled, or expired medication shall be in compliance with federal and state law. Prior to disposal school personnel shall make a reasonable attempt to return medication by providing written notification that expired, discontinued, or unused medications need to be picked up. If medication is not picked up by the date specified, disposal shall be in accordance with the disposal procedures for the specific category of medication.

Legal Reference: Iowa Code §§124.101(1), 147.107, 152.1, 155A.4(2), 280.16, 280.23 (2009)
   Education [281] IAC § 14.1, .2
                                Pharmacy [657] IAC §8.32((124, 155A)
                                Nursing Board [655] IAC §6.2(152)

Cross Reference: 506       Student Records
                                       507       Student Health and Well-Being
                                       603.3 Special Education
                                     607.2 Student Health Services

Approved: 3/15/10
Reviewed: 4/22/15
Revised:6/24/20; 9/27/23

dawn.gibson.cm… Wed, 06/17/2026 - 20:25

507.2E1 - Authorization Asthma or Airway Constricting Medication Self-Administration Consent Form

_____________________________ ___/___/___ _________________ ___/___/___
Student's Name (Last), (First) (Middle) Birthday School Date

In accordance with applicable laws, students with asthma, airway constricting diseases, respiratory distress or students at risk of anaphylaxis who us epinephrine auto-injectors may self-administer their medication upon the written approval of the student’s parents or guardians and prescribing licensed health care professional regardless of competency. The following must occur for a student to self-administer asthma medication, bronchodilator canisters or spacers, other airway constricting disease medication or to self-administer an epinephrine auto-injector:

Parent/guardian provides signed, dated authorization for student medication self-administration.
Parent/guardian provides a written statement from the student's licensed health care professional (A person licensed under chapter 148 to practice medicine and surgery or osteopathic medicine and surgery, an advanced registered nurse practitioner licensed under chapter 152 or 152 and registered with the board of nursing, or a physician assistant licensed to practice under the supervision of a physician as authorized in chapters 147and 148C) containing the following:
- Name and purpose of the medication,
- Prescribed dosage, and,
- Times or special circumstances under which the medication or epinephrine auto-injector is to be administered.
The medication is in the original, labeled container as dispensed or the manufacturer's labeled container containing the student name, name of the medication, directions for use, and date.
Authorization is renewed annually. If any changes occur in the medication, dosage or time of administration, the parent is to notify school officials immediately. The authorization shall be reviewed as soon as practical.

Provided the above requirements are fulfilled, the school shall permit the self-administration of the prescribed medication by a student while in school, at school-sponsored activities, under the supervision of school personnel, and before or after normal school activities, such as while in before-school or after-school care on school-operated property. If the student abuses the self-administration policy, the ability to self-administer may be withdrawn by the school or discipline may be imposed, after notification is provided to the student's parent.

Pursuant to state law, the school district or accredited nonpublic school and its employees are to incur no liability, except for gross negligence, as a result of any injury arising from self-administration of medication or use of an epinephrine auto-injector by the student. The parent or guardian of the student shall sign a statement acknowledging that the school district or nonpublic school is to incur no liability, except for gross negligence, as a result of self-administration of medication or an epinephrine auto-injector by the student as provided by law.

__________________ _________ _____________________________ ______________
Medication Dosage Route Time

_____________________________________________________________________________
Purpose of Medication & Administration /Instructions

____________________________________ ___________________________
Special Circumstances Discontinue/Re-Evaluate/

Follow-up Date

_____________________________________________ __________________________
Prescriber’s Signature Date

_____________________________________________ __________________________
Prescriber’s Address Emergency Phone

● I request the above named student possess and self-administer asthma or other airway constricting disease medication(s) and/or an epinephrine auto-injector at school and in school activities according to the authorization and instructions.

● I understand the school district and its employees acting reasonably and in good faith shall incur no liability for any improper use of medication or for supervising, monitoring, or interfering with a student's self-administration of medication or use of an epinephrine auto-injector. I acknowledge that the school district is to incur no liability, except for gross negligence, as a result of self-administration of medication or use of an epinephrine auto-injector by the student.

● I agree to coordinate and work with school personnel and notify them when questions arise or relevant conditions change.

● I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment.

● I agree the information is shared with school personnel in accordance with the Family Education Rights and Privacy Act (FERPA) and any other applicable laws.

● I agree to provide the school with back-up medication approved in this form.

______________________________________________ ________________________

Parent/Guardian Signature (agreed to above statement) Date

______________________________________________ ________________________ Parent/Guardian Address Home Phone

___________________________
Business Phone

____________________________________________________________________________
Self-Administration Authorization Additional Information

dawn.gibson.cm… Wed, 06/17/2026 - 20:27

507.2E2 - Parental Authorization and Release Form for the Administration of Prescription Medication to Students

_________________________________ ___/___/___ _________________ ___/___/___

Student's Name (Last), (First), (Middle) Birthday School Date

School medications and health services are administered following these guidelines:

● Parent has provided a signed, dated authorization to administer prescription medication and/or provide special health services listed. Electronic signatures meet the requirement of written signatures.

● The prescribed medication is in the original, labeled container as dispensed or the manufacturer's labeled container.

● The prescription medication label contains the student’s name, name of the medication, the medication dosage, time(s) to administer, route to administer and date.

● Authorization is renewed annually and immediately as soon as practical when the parent notifies the school that changes are necessary.

_______________________________ ______________ ____________ _____________ Medication/Health Care Dosage Route Time at School

Special Health Services and instructions, as indicated:

___________________________________________________________________________________

___________________________

Discontinue/Re-Evaluate/Follow-up Date for Prescribed Medication or Special Health Services listed

______________________________________ ___________________________

Prescriber’s Signature Date

And credentials (when indicated for health service delivery)

______________________________________ _______________________

Parent/Guardian Signature Date

______________________________________ ________________________ Parent/Guardian Address Phone

Additional Information

Approved: 3/15/10
Reviewed: 4/22/15
Revised:6/24/20; 9/27/23

dawn.gibson.cm… Wed, 06/17/2026 - 20:29

507.2E3 - Parental Authorization and Release Form for Independent Self Carry and Administration of Prescribed Medication or Independent Delivery of Health Services by the Student

_________________________________ ___/___/___ _________________ ___/___/___
Student's Name (Last), (First), (Middle) Birthday School Date

I request the above-named student (Parent/Guardian initial all that apply)

______ Carry and complete co-administration of prescribed medication, when competency has been demonstrated to licensed health personnel working under the auspices of the school. In accordance with applicable laws, students with asthma, airway constricting diseases, respiratory distress or students at risk of anaphylaxis who use epinephrine auto-injectors may self-administer their medication upon the written approval of the student’s parents and prescribing licensed health care professional regardless of competency. The information provided by the parent for medication administration is confidential as provided by the Family Education Rights and Privacy Act (FERPA) and any other applicable laws. I agree to provide safe delivery of the medication to and from school and to pick up remaining medication at the end of the school year or when medication is expired. If the students abuses the self-administration policy, the ability to self-administer may be withdrawn by the school or discipline may be imposed, after notification is provided to the student’s parent.

_____________________________________________________________________________________
Prescribed Medication Dosage Route Time at School

______ Co-administer, participate in planning, management and implementation of special health services at school and school activities after demonstration of proficiency to licensed health personnel working under the auspices of the school. The information provided by the parent for health service delivery is confidential as provide by the Family Education Rights and Privacy Act (FERPA) and any other applicable laws. I agree to coordinate and work with school personnel and the prescriber (if indicated) when questions arise. I agree to provide safe delivery of the student’s equipment necessary for health service delivery to and from school and to pick up remaining equipment at the end of the school year.

Special Health Services Delivery: _________________________________________________________

Procedures for abandoned medication disposal shall be in accordance with applicable laws.

/ /
Prescriber’s Signature Date

and credentials (when indicated for health service delivery)

Parent/Guardian Signature Date

_______________________________________ __________________________
Parent/Guardian address Home phone

dawn.gibson.cm… Wed, 06/17/2026 - 20:30