AGENCY: Davis County School District (Utah). Hill Field Elementary School
SERIES: 10126
TITLE: Medication administration authorizations
DATES: 1979-
ARRANGEMENT: Chronological, thereunder alphabetical by student name
DESCRIPTION: This form authorizes school personnel to administer medication during the school day. This signed form with the prescription bottle indicating current dosage must be presented to the school before any medications may be dispensed. According, to UCA^52A-11-601^(1)^(1991) "a public or private school .^.^.^ may provide for the administration of medication to any student of the school." "Medications may only be administered to a student if the student's parent or legal guardian has provided a current written and signed request that medication be administered during regular school hours to the student; and student's physician, dentist, nurse practitioner, or physician assistant has provided a signed statement describing the method, amount, and time schedule" (UCA^53A-11-601(b)^(1991)). This form includes the student's name, birth date, address, parent's/guardian's name and telephone numbers (work and home), grade level, classroom teacher, medical personnel statement completed by physician or dentist including name, professional title, address, name and type of medication, dosage/amount to be given, frequency/times to be administered, duration/length of time medication is anticipated to be needed, method of administration, anticipated reaction to medication (symptoms, side effects), physician's signature indicating position, parent's/guardian signature and date requesting the administration of medication.
RETENTION
Retain for 7 year(s) after separation
DISPOSITION
Destroy.
RETENTION AND DISPOSITION AUTHORIZATION
These records are in Archives' permanent custody.
APPROVED: 09/1992
FORMAT MANAGEMENT
Paper: Retain in Office for 7 years after student leaves elementary school and then destroy.
APPRAISAL
Administrative Legal
This disposition is based the advice of the attorneys from the State Office of Education.