St Patrick's School Camperdown eNewsletter

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Medication Authority Form

Please use this form when a student requires medication during school hours or is participating in a school activity / camp. Wherever possible, medication should be scheduled outside the school hours, e.g. medication required three times a day is generally not required during a school day: it can be taken before and after school and before bed.

The school collects personal information so as the school can plan and support the health care needs of the student. Without the provision of this information the quality of the health support provided may be affected.
The information may be disclosed to relevant school staff and appropriate medical personnel, including those engaged in providing health support as well as emergency personnel, where appropriate, or where authorised or required by another law. You are able to request access to the personal information that we hold about you/your child and to request that it be corrected. Please contact the school directly on 0355931962 for further inquiries.
Please use this form when a student requires medication during school hours or is participating in a school activity / camp.
This form is NOT for recording the administration of emergency medication. Use the student health support plan for this purpose.

PARENTS / GARDIAN DETAILS

Last Name

First Name *

Email / MOB *

Student Details

Student Last Name *

Student First Name *

Date of Birth / Age *

Grade *

Name or Medication *

Dosage *

Time/s to be adminitered *

Requirements (with/out food) *

Notes

Please ensure that medication delivered to the school :
☐ is handed to the relevant staff member.
☐ is in its original package.
☐ the pharmacy label matches the information included in this form.
Monitoring effects of Medication
Please note: School staff do not monitor the effects of medication and will seek emergency medical
assistance if concerned about a student’s behaviour following medication.