3416F-1-Standing-Order-Administering -Medicines-to-Students

Dear Parent/Guardians, 

Butte School District # 1 requires your consent in order to administer the over-the counter medications listed below.  ALL OTHER MEDICATIONS (PRESCRIPTION, OVER THE COUNTER, and ALTERNATIVE MEDICINES AND SUPPLEMENTS) require a specific order for your child by a health care provider with prescriptive authority. 

Standing Orders for Students of Butte School District # 1

Grade	Acetaminophen (Tylenol)  Dose- no more than every 4 hours	Ibuprofen (Advil/Motrin) Dose – no more than every 8 hours	Calcium carbonate (Tums)  as directed  – for upset stomach	Diphenhydramine (Benadryl) )- no more than 1 dose every 6 hours  for minor allergic reactions – parent/guardian will be notified when possible prior to administering Benadryl.	Hydrocortisone Cream 1% for minor rash – topical application – as directed
K	240 mg chewable or melt away tabs	200 mg chewable	1-2 chewable tabs	25 mg melt away/chew tabs	Light layer applied to affected area
Grades 1-4	320 mg chewable or 325 mg swallow tab if able	200 mg chewable or swallow tab if able	1-2 chewable tabs	25 mg melt away/chew tabs or 25 mg swallow tab or capsule if able	Light layer applied to affected area
Grades 5-8	650 mg  total dose	400 mg total dose	1-2 chewable tabs	25 mg dose	Light layer applied to affected area
Grades 9-12	650 mg total dose	400 mg total dose	1-3 chewable tabs	25 mg  dose	Light layer applied to affected area

I give permission for the school nurse and/or other designee to administer the above medications to:

________________________________ (Students Name)     _________________   (Date of Birth)

My child is allergic to: _____________________________________________________

Parent/Guardian Signature: _________________________          Date: ____________________

Physicians Signature: ___________________________________________             

Date: ____________________________________

I give permission to the Butte School District #1 School nurses or Butte School District #1 Schools’ designee to give my child the above-mentioned medications for comfort measures. I further agree to indemnify or hold harmless the Butte School District #1 and its agents from all claims as a result of any and all acts performed under this authority. I will inform the school if there is a change in any of this information.

Approved February 2017