Amy Loehnis, RN, LSN, BSN - Westerville City Schools

Westerville City School District

Westerville City Schools

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District Medication Authorization Forms Files & Links

Medication Authorization Forms

Asthma Packet (asthma packet 2017-2018.pdf)
Use these forms for Asthma management. Authorization for self medication is included. Your doctor and you need to complete the form(s).
Epinephrine Auto Injectors (allergy allergy packet.pdf)
This is a detailed packet of forms required for Epi-Auto Injectors. Your doctor and you need to complete the forms. If your student will self-carry an Epi-Auto Injector, the Allergy Action Plan is required as is a "back-up" Auto Injector for faculty to keep.
Prescription Medication Form (5330 f1 med form revised_1.pdf)
This form is needed for staff to administer any (Rx or OTC) medications to your student. Both you and your doctor need to complete this form.
OTC Self Medications (5330f1a-self med otcv2.pdf)
Please be sure to include the mg dose and how many hours between doses, and educate your student on the safe use of the medicine. Warn your student that sharing medicine with a friend is prohibited.