Medication Plans and Drop Off Policies:

Please review the following information and have your child’s health care provider(s) complete and sign the applicable forms. These forms must be submitted to the clinic prior to the start of the school year. If your student is starting a medication or requires a new medication or plan during the school year, these forms must be received by the clinic before medication can be administered.

School Action Plans: 

A school action plan form is required for if your child has asthma, diabetes, epilepsy, a food allergy, or any medical condition that requires a school action plan. Please fill out the appropriate form below or bring one provided by your child’s health care provider.

• Asthma Action Plan – In addition to completing this form, you will need to make an appointment using the "click here" link at the top of the page to drop off your form and your child’s medication.
  
• Anaphylaxis (LAMP) Plan – In addition to completing this form, a photo of your child is also requested. Please click the link below to schedule an appointment with the nursing team to drop off the action plan and your child’s medication(s).
• Diabetes Action Plan (DMMP) – Information, forms, and instructions are can be found by clicking the link. Please fill out the form and have a health care provider sign it. Please schedule an appointment with the nurses to drop off the action plan. Please note that we will discuss a full plan of care during this meeting, so it may take a little longer than the 15 minute time slots allotted in the sign up. 
• Seizure Action Plan (SAP) – Please have the form completely filled out and signed by the health care provider. You will need to make an appointment with the clinic to drop off the forms and rescue medication (if applicable). 
• Additional forms may be downloaded and printed from the Virginia Department of Health website.

Medication Drop Off Policies & Form Download

Please make an appointment with the clinic nurses to drop off ALL DAILY OR AS NEEDED MEDICATIONS to be administered to students of any age during the school day. 

Virginia law and Diocesan requirements that allow clinic nurses to administer medications are very specific. It is important for the nurses to review that every healthcare provider order, parent/guardian signed form, and prescription bottle or over the counter container meets the mandated state guidelines.

• ALL  prescription and nonprescription medications (over the counter medications) require a health care provider signature on this form. Parents/guardians, must sign and date the form as well.
• Prescription Medications: Must be hand delivered by parents/guardians to the clinic in the original container/package containing:
• The name of the student;
• Correct medication name and dosage information; and
• Indicating an expiration date that is valid for the current school year. 
• Medications not meeting these requirements will not be accepted.
• Nonprescription/Over the Counter Medications:  Must be hand delivered by parents/guardians to the clinic in the original, unopened container/package that is not expired. Medications not meeting these requirements will not be accepted.

Additional Information About Medications:

• Students are not allowed to deliver the medications to the clinic.
• Students are never permitted to carry prescription or nonprescription medications on their person or in their backpack per school and diocesan policy unless they have prior authorization from the School Nurses.
• Students are never permitted to self-administer prescription medications or over the counter medications per school and diocesan policy unless they have prior authorization from the School Nurses.