School Nurse Permission Letter To Administer Medication Template

You can open the School Nurse Permission Letter To Administer Medication Template in multiple formats, including PDF, Word, and Google Docs.

Open Template

Sample

School Nurse Permission Letter To Administer Medication Template

Printable | Editable Form

PDF 1 PDF 2

Examples

School Nurse Permission Letter To Administer Medication Template (1)
To:
[Name of the School Nurse]
[School Name]
[School Address]
[School Phone Number]
From:
[Parent/Guardian’s Name]
[Parent/Guardian’s Address]
[Parent/Guardian’s Phone Number]
[Parent/Guardian’s Email]
Date:
[Date]
Subject:
Permission to Administer Medication to [Child’s Name]
Dear [Name of the School Nurse],
I, [Parent/Guardian’s Name], am writing to formally grant permission for you to administer medication to my child, [Child’s Name], during school hours as needed. The details of the medication are as follows:
Medication Name:
[Name of Medication]
Dosage:
[Dosage Instructions]
Administration Time:
[Specify Times]
Reason for Medication:
[Specify Reason for Medication]
I acknowledge that it is my responsibility to ensure that the medication is provided to the school nurse in its original packaging, labeled with my child’s name, the prescribed dosage, and any relevant instructions.
I also understand that the school nurse will keep a record of all administered medication and will communicate any concerns regarding my child’s health while under medication supervision.
Please feel free to contact me at [Parent/Guardian’s Phone Number] or [Parent/Guardian’s Email] should you have any questions or require further information.
Thank you for your attention to this matter.
Sincerely,
[Parent/Guardian’s Signature]
[Parent/Guardian’s Name]
School Nurse Permission Letter To Administer Medication Template (2)
To:
[Name of the School Nurse]
[School Name]
[School Address]
[School Phone Number]
From:
[Parent/Guardian’s Name]
[Parent/Guardian’s Address]
[Parent/Guardian’s Phone Number]
[Parent/Guardian’s Email]
Date:
[Date]
Subject:
Consent to Administer Medication to [Child’s Name]
Dear [Name of the School Nurse],
I, [Parent/Guardian’s Name], hereby give my consent for my child, [Child’s Name], to receive the following medication during school hours:
Medication Details:
– Medication Name: [Name of Medication]
– Dosage: [Dosage Instructions]
– Administration Time: [Specify Times]
– Allergy Information: [Specify Allergies if any]
This medication is being administered for [Specify Health Condition/Reason] as prescribed by our physician, [Doctor’s Name], who can be reached at [Doctor’s Phone Number].
I ensure that the medication will be provided in the original pharmacy packaging, along with any necessary prescriptions or instructions. I acknowledge the risks and responsibilities that come with medication administration in a school setting.
In case of any adverse reactions or if my child experiences any unusual side effects, please contact me immediately at [Parent/Guardian’s Phone Number] or [Parent/Guardian’s Email].
Thank you for your cooperation and support in ensuring my child’s health and safety at school.
Best regards,
[Parent/Guardian’s Signature]
[Parent/Guardian’s Name]

Template Online

Format

Please complete the form below to create the School Nurse Permission Letter to Administer Medication Template. All fields must be filled out to ensure a clear and complete agreement. We provide examples to guide you through each step.

School Nurse Permission Letter to Administer Medication Template

1. Student Information


2. Parent/Guardian Information


3. Medication Information


4. Purpose of Medication

5. Administration Instructions

6. Emergency Contact Information

7. Authorization

8. Signature and Date


PDF

WORD

Google Docs

Printable

School Nurse Permission Letter To Administer Medication Template

Printable | Editable Form

PDF 1 PDF 2

School Nurse Permission Letter To Administer Medication Template