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5141.21P
STUDENTS
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS
First Reading 3/8/22 (Shipman & Goodwin)
A. Defini ons
Administra on of medica on means any one of the following ac vi es: handling,
storing, preparing or pouring of medica on; conveying it to the student
according to the medica on order; observing the student inhale, apply, swallow,
or self-inject the medica on, when applicable; documen ng that the medica on
was administered; and coun ng remaining doses to verify proper administra on
and use of the medica on.
Authorized prescriber means a physician, den st, optometrist, advanced prac ce
registered nurse or physician assistant, and, for interscholas c and intramural
athle c events only, a podiatrist.
Before or A er School Program means any child care program operated and
administered by a local or regional board of educa on exempt from licensure by
the Office of Early Childhood pursuant to subdivision (1) of subsec on (b) of
Sec on 19a-77 of the Connec cut General Statutes. Such programs do not
include public or private en es licensed by the Office of Early Childhood or
board of educa on enhancement programs and extra-curricular ac vi es.
Cartridge Injector means an automa c prefilled cartridge injector or similar
automa c injectable equipment used to deliver epinephrine in a standard dose
for emergency first aid response to allergic reac ons.
Coach means any person holding a coaching permit who is hired by a local or
regional board of educa on to coach for a sport season.
Controlled drugs means those drugs as defined in Conn. Gen. Stat. Sec on 21a-
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 1 of 34
240.
Cumula ve health record means the cumula ve health record of a pupil
mandated by Conn. Gen. Stat. Sec on 10-206.
Director means the person responsible for the day-to-day opera ons of any
school readiness program or before-and-a er school program.
Eligible student means a student who has reached the age of eighteen or is an
emancipated minor.
Error means:
(1) the failure to do any of the following as ordered:
(a) administer a medica on to a student;
(b) administer medica on within the me designated by the
prescribing physician;
(c) administer the specific medica on prescribed for a
student;
(d) administer the correct dosage of medica on;
(e) administer medica on by the proper route;
(f) administer the medica on according to generally accepted
standards of prac ce; or
(2) the administra on of medica on to a student which is not ordered, or
which is not authorized in wri ng by the parent or guardian of such
student, except for the administra on of epinephrine or naloxone for the
purpose of emergency first aid as set forth in Sec ons D and E below.
Guardian means one who has the authority and obliga ons of guardianship of
the person of a minor, and includes: (1) the obliga on of care and control; and
(2) the authority to make major decisions affec ng the minor's welfare,
including, but not limited to, consent determina ons regarding marriage,
enlistment in the armed forces and major medical, psychiatric or surgical
treatment.
Intramural athle c events means tryouts, compe on, prac ce, drills, and
transporta on to and from events that are within the bounds of a school district
for the purpose of providing an opportunity for students to par cipate in
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 2 of 34
physical ac vi es and athle c contests that extend beyond the scope of the
physical educa on program.
Interscholas c athle c events means events between or among schools for the
purpose of providing an opportunity for students to par cipate in compe ve
contests that are highly organized and extend beyond the scope of intramural
programs and includes tryouts, compe on, prac ce, drills and transporta on to
and from such events.
Inves ga onal drug means any medica on with an approved inves ga onal new
drug (IND) applica on on file with the Food and Drug Administra on (FDA),
which is being scien fically tested and clinically evaluated to determine its
efficacy, safety and side effects and which has not yet received FDA approval.
Licensed athle c trainer means a licensed athle c trainer employed by the
school district pursuant to Chapter 375a of the Connec cut General Statutes.
Medica on means any medicinal prepara on, both prescrip on and non-
prescrip on, including controlled drugs, as defined in Conn. Gen. Stat. Sec on
21a-240. This defini on includes Aspirin, Ibuprofen or Aspirin subs tutes
containing Acetaminophen.
Medica on Emergency means a life-threatening reac on of a student to a
medica on.
Medica on plan means a documented plan established by the school nurse in
conjunc on with the parent and student regarding the administra on of
medica on in school. Such plan may be a stand-alone plan, part of an
individualized health care plan, an emergency care plan or a medica on
administra on form.
Medica on order means the authoriza on by an authorized prescriber for the
administra on of medica on to a student which shall include the name of the
student, the name and generic name of the medica on, the dosage of the
medica on, the route of administra on, the me of administra on, the
frequency of administra on, the indica ons for medica on, any poten al side
effects including overdose or missed dose of the medica on, the start and
termina on dates not to exceed a 12-month period, and the wri en signature of
the prescriber.
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 3 of 34
Nurse means an advanced prac ce registered nurse, a registered nurse or a
prac cal nurse licensed in Connec cut in accordance with Chapter 378, Conn.
Gen. Stat.
Occupa onal Therapist means an occupa onal therapist employed full me by
the local or regional board of educa on and licensed in Connec cut pursuant to
Chapter 376a of the Connec cut General Statutes.
Optometrist means an optometrist licensed to provide optometry pursuant to
Chapter 380 of the Connec cut General Statutes.
Paraprofessional means a health care aide or assistant or an instruc onal aide or
assistant employed by the local or regional board of educa on who meets the
requirements of such board of employment as a health care aide or assistant or
instruc onal aide or assistant.
Physical therapist means a physical therapist employed full me by the local or
regional board of educa on and licensed in Connec cut pursuant to Chapter 376
of the Connec cut General Statutes.
Physician means a doctor of medicine or osteopathy licensed to prac ce
medicine in Connec cut pursuant to Chapters 370 and 371 of the Connec cut
General Statutes, or licensed to prac ce medicine in another state.
Podiatrist means an individual licensed to prac ce podiatry in Connec cut
pursuant to Chapter 375 of the Connec cut General Statutes.
Principal means the administrator in the school.
Research or study medica ons means FDA-approved medica ons being
administered according to an approved study protocol. A copy of the study
protocol shall be provided to the school nurse along with the name of the
medica on to be administered and the acceptable range of dose of such
medica on to be administered.
School means any educa onal facility or program which is under the jurisdic on
of the Board excluding extracurricular ac vi es.
School nurse means a nurse appointed in accordance with Conn. Gen. Stat.
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 4 of 34
Sec on 10-212.
School nurse supervisor means the nurse designated by the local or regional
board of educa on as the supervisor or, if no designa on has been made by the
board, the lead or coordina ng nurse assigned by the board.
School readiness program means a program that receives funds from the State
Department of Educa on for a school readiness program pursuant to subsec on
(b) of Sec on 10-16p of the Connec cut General Statutes and exempt from
licensure by the Office of Early Childhood pursuant to subdivision (1) of
subsec on (b) of Sec on 19a-77 of the Connec cut General Statutes.
Self-administra on of medica on means the control of the medica on by the
student at all mes and is self-managed by the student according to the
individual medica on plan.
Teacher means a person employed full me by the Board who has met the
minimum standards as established by the Board for performance as a teacher
and has been approved by the school medical advisor and school nurse to be
designated to administer medica ons pursuant to the Regula ons of
Connec cut State Agencies Sec ons 10-212a-1 through 10-212a-7.
B. General Policies On Administra on of Medica ons
(1) Except as provided below in Sec on D, no medica on, including non-
prescrip on drugs, may be administered by any school personnel
without:
(a) the wri en medica on order of an authorized prescriber;
(b) the wri en authoriza on of the student's parent
or guardian or eligible student; and
(c) the wri en permission of a parent for the exchange of
informa on between the prescriber and the school nurse
necessary to ensure safe administra on of such medica on.
(2) Prescribed medica ons shall be administered to and taken by only the
person for whom the prescrip on has been wri en.
(3) Except as provided in Sec on D, medica ons may be administered only
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 5 of 34
by a licensed nurse or, in the absence of a licensed nurse, by:
(a) a full- me principal, a full- me teacher, or a full- me licensed
physical or occupa onal therapist employed by the school district.
A full- me principal, teacher, licensed physical or occupa onal
therapist employed by the school district may administer oral,
topical, intranasal or inhalant medica ons. Such individuals may
administer injectable medica ons only to a student with a
medically diagnosed allergic condi on that may require prompt
treatment to protect the student against serious harm or death.
(b) students with chronic medical condi ons who are able to possess,
self-administer, or possess and self-administer medica on,
provided all of the following condi ons are met:
(i) an authorized prescriber provides a wri en medica on
order, including the recommenda on for possession, self-
administra on, or possession and self-administra on;
(ii) there is a wri en authoriza on for possession, self-
administra on, or possession and self-administra on from
the student's parent or guardian or eligible student;
(iii) the school nurse has developed a plan for possession, self-
administra on, or possession and self-administra on, and
general supervision, and has documented the plan in the
student’s cumula ve health record;
(iv) the school nurse has assessed the student’s competency
for self-administra on and deemed it safe and
appropriate, including that the student: is capable of
iden fying and selec ng the appropriate medica on by
size, color, amount or other label iden fica on; knows the
frequency and me of day for which the medica on is
ordered; can iden fy the presen ng symptoms that
require medica on; administers the medica on
appropriately; maintains safe control of the medica on at
all mes; seeks adult supervision whenever warranted;
and cooperates with the established medica on plan;
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 6 of 34
(v) the principal, appropriate teachers, coaches and other
appropriate school personnel are informed the student is
possessing, self-administering, or possessing and self-
administering prescribed medica on;
(vi) such medica on is transported to school and maintained
under the student's control in accordance with this policy;
and
(vii) controlled drugs, as defined in this policy, may not be
possessed or self-administered by students, except in
extraordinary situa ons, such as interna onal field trips,
with approval of the school nurse supervisor and the
school medical advisor in advance and development of an
appropriate plan.
(c) a student diagnosed with asthma who is able to self-administer
medica on shall be permi ed to retain possession of an
asthma c inhaler at all mes while a ending school, in order to
provide for prompt treatment to protect such child against serious
harm or death, provided all of the following condi ons are met:
(i) an authorized prescriber provides a wri en order
requiring the possession of an inhaler by the student at all
mes in order to provide for prompt treatment in order to
protect the child against serious harm or death and
authorizing the student’s self-administra on of
medica on, and such wri en order is provided to the
school nurse;
(ii) there is a wri en authoriza on from the student's parent
or guardian regarding the possession of an inhaler by the
student at all mes in order to protect the child against
serious harm or death and authorizing the student’s self-
administra on of medica on, and such wri en
authoriza on is provided to the school nurse;
(iii) the condi ons set forth in subsec on (b) above have been
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 7 of 34
met, except that the school nurse’s review of a student’s
competency to self-administer an inhaler for asthma in the
school se ng shall not be used to prevent a student from
retaining and self-administering an inhaler for asthma.
Students may self-administer medica on with only the
wri en authoriza on of an authorized prescriber and
wri en authoriza on from the student’s parent or
guardian or eligible student; and
(iv) the condi ons for self-administra on meet any regula ons
as may be imposed by the State Board of Educa on in
consulta on with the Commissioner of Public Health.
(d) a student diagnosed with an allergic condi on who is able to self-
administer medica on shall be permi ed to retain possession of a
cartridge injector at all mes while a ending school, in order to
provide for prompt treatment to protect such child against serious
harm or death, provided all of the following condi ons are met:
(i) an authorized prescriber provides a wri en order
requiring the possession of a cartridge injector by the
student at all mes in order to provide for prompt
treatment in order to protect the child against serious
harm or death and authorizing the student’s possession,
self-administra on, or possession and self-administra on
of medica on, and such wri en order is provided to the
school nurse;
(ii) there is a wri en authoriza on from the student’s parent
or guardian regarding the possession of a cartridge
injector by the student at all mes in order to protect the
child against serious harm or death and authorizing the
student’s possession, self-administra on, or possession
and self-administra on of medica on, and such wri en
authoriza on is provided to the school nurse;
(iii) the condi ons set forth in subsec on (b) above have been
met, except that the school nurse’s review of a student’s
competency to self-administer cartridge injectors for
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 8 of 34
medically-diagnosed allergies in the school se ng shall
not be used to prevent a student from retaining and self-
administering a cartridge injector for medically-diagnosed
allergies. Students may self-administer medica on with
only the wri en authoriza on of an authorized prescriber
and wri en authoriza on from the student’s parent or
guardian or eligible student; and
(iv) the condi ons for self-administra on meet any regula ons
as may be imposed by the State Board of Educa on in
consulta on with the Commissioner of Public Health.
(e) a student with a medically diagnosed life-threatening allergic
condi on may possess, self-administer, or possess and self-
administer medica on, including but not limited to medica on
administered with a cartridge injector, to protect the student
against serious harm or death, provided the following condi ons
are met:
(i) the parent or guardian of the student has provided wri en
authoriza on for the student to possess, self-administer,
or possess and self-administer such medica on; and
(ii) a qualified medical professional has provided a wri en
order for the possession, self-administra on, or possession
and self-administra on.
(f) a coach of intramural or interscholas c athle c events or licensed
athle c trainer who has been trained in the administra on of
medica on, during intramural or interscholas c athle c events,
may administer inhalant medica ons prescribed to treat
respiratory condi ons and/or medica on administered with a
cartridge injector for students with medically diagnosed allergic
condi ons which may require prompt treatment to protect the
student against serious harm or death, provided all of the
following condi ons are met:
(i) the school nurse has determined that a self-administra on
plan is not viable;
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 9 of 34
(ii) the school nurse has provided to the coach a copy of the
authorized prescriber’s order and parental permission
form;
(iii) the parent/guardian has provided the coach or licensed
athle c trainer with the medica on in accordance with
Sec on K of this policy, and such medica on is separate
from the medica on stored in the school health office for
use during the school day; and
(iv) the coach or licensed athle c trainer agrees to the
administra on of emergency medica on and implements
the emergency care plan, iden fied in Sec on H of this
policy, when appropriate.
(g) an iden fied school paraprofessional who has been trained in the
administra on of medica on, provided medica on is
administered only to a specific student in order to protect that
student from harm or death due to a medically diagnosed allergic
condi on, except as provided in Sec on D below, and the
following addi onal condi ons are met:
(i) there is wri en authoriza on from the student's
parents/guardian to administer the medica on in school;
(ii) medica on is administered pursuant to the wri en order
of (A) a physician licensed under chapter 370 of the
Connec cut General Statutes, (B) an optometrist licensed
to prac ce optometry under chapter 380 of the
Connec cut General Statutes, (C) an advanced prac ce
registered nurse licensed to prescribe in accordance with
sec on 20-94a of the Connec cut General Statutes, or (D)
a physician assistant licensed to prescribe in accordance
with sec on 20-12d of the Connec cut General Statutes;
(iii) medica on is administered only with approval by the
school nurse and school medical advisor, if any, in
conjunc on with the school nurse supervisor and under
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 10 of 34
the supervision of the school nurse;
(iv) the medica on to be administered is limited to
medica ons necessary for prompt treatment of an allergic
reac on, including, but not limited to, a cartridge injector;
and
(v) the paraprofessional shall have received proper training
and supervision from the school nurse in accordance with
this policy and state regula ons.
(h) a principal, teacher, licensed athle c trainer, licensed physical or
occupa onal therapist employed by the Board, coach or school
paraprofessional, provided medica on is an epilep c medica on,
including by rectal syringe, administered only to a specific student
with a medically diagnosed epilep c condi on that requires
prompt treatment in accordance with the student’s individual
seizure ac on plan, and the following addi onal condi ons are
met:
(i) there is wri en authoriza on from the student’s
parents/guardians to administer the medica on;
(ii) a wri en order for such administra on has been received
from the student’s physician licensed under Chapter 370
of the Connec cut General Statutes;
(iii) the principal, teacher, licensed athle c trainer, licensed
physical or occupa onal therapist employed by the Board,
coach or school paraprofessional is selected by the school
nurse and school medical advisor, if any, and voluntarily
agrees to administer the medica on;
(iv) the principal, teacher, licensed athle c trainer, licensed
physical or occupa onal therapist employed by the Board,
coach or school paraprofessional annually completes the
training program established by the Connec cut State
Department of Educa on and the Associa on of School
Nurses of Connec cut, and the school nurse and medical
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 11 of 34
advisor, if any, have a ested, in wri ng, that such training
has been completed; and
(v) the principal, teacher, licensed athle c trainer, licensed
physical or occupa onal therapist employed by the Board,
coach or school paraprofessional receives monthly reviews
by the school nurse to confirm competency to administer
an epilep c medica on.
(i) a director of a school readiness program or a before or a er
school program, or the director’s designee, provided that the
medica on is administered:
(i) only to a child enrolled in such program; and
(ii) in accordance with Sec on L of this policy.
(j) a licensed prac cal nurse, a er the school nurse has established
the medica on plan, provided that the licensed prac cal nurse
may not train or delegate the administra on of medica on to
another individual, and provided that the licensed prac cal nurse
can demonstrate one of the following:
(i) training in administra on of medica ons as part of their
basic nursing program;
(ii) successful comple on of a pharmacology course and
subsequent supervised experience; or
(iii) supervised experience in the administra on of medica on
while employed in a health care facility.
(4) Medica ons may also be administered by a parent or guardian to his/her
own child on school grounds.
(5) Inves ga onal drugs or research or study medica ons may be
administered only by a licensed nurse. For FDA-approved medica ons
being administered according to a study protocol, a copy of the study
protocol shall be provided to the school nurse along with the name of the
medica on to be administered and the acceptable range of dose of such
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 12 of 34
medica on to be administered.
C. Diabe c Students
(1) The Colchester Board of Educa on (the “Board”) permits blood glucose
tes ng by students who have a wri en order from a physician or an
advanced prac ce registered nurse sta ng the need and capability of
such student to conduct self-tes ng.
(2) The Board will not restrict the me or loca on of blood glucose tes ng by
a student with diabetes on school grounds who has wri en authoriza on
from a parent or guardian and a wri en order from a physician or an
advanced prac ce registered nurse sta ng that such child is capable of
conduc ng self-tes ng on school grounds.
(3) In the absence or unavailability of the school nurse, select school
employees may administer medica on with injectable equipment used to
administer glucagon to a student with diabetes that may require prompt
treatment in order to protect the student against serious harm or death,
under the following condi ons:
(a) The student’s parent or guardian has provided wri en
authoriza on;
(iii) supervised experience in the administra on of medica on
while employed in a health care facility.
(4) Medica ons may also be administered by a parent or guardian to his/her
own child on school grounds.
(5) Inves ga onal drugs or research or study medica ons may be
administered only by a licensed nurse. For FDA-approved medica ons
being administered according to a study protocol, a copy of the study
protocol shall be provided to the school nurse along with the name of the
medica on to be administered and the acceptable range of dose of such
medica on to be administered.
C. Diabe c Students
(1) The Colchester Board of Educa on (the “Board”) permits blood glucose
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 13 of 34
tes ng by students who have a wri en order from a physician or an
advanced prac ce registered nurse sta ng the need and capability of
such student to conduct self-tes ng.
(2) The Board will not restrict the me or loca on of blood glucose tes ng by
a student with diabetes on school grounds who has wri en authoriza on
from a parent or guardian and a wri en order from a physician or an
advanced prac ce registered nurse sta ng that such child is capable of
conduc ng self-tes ng on school grounds.
(3) In the absence or unavailability of the school nurse, select school
employees may administer medica on with injectable equipment used to
administer glucagon to a student with diabetes that may require prompt
treatment in order to protect the student against serious harm or death,
under the following condi ons:
(a) The student’s parent or guardian has provided wri en
authoriza on;
(c) The school employee is selected by either the school nurse or
principal and is a principal, teacher, licensed athle c trainer,
licensed physical or occupa onal therapist employed by a school
district, coach or school paraprofessional;
(d) The school nurse shall provide general supervision to the selected
school employee;
(e) The selected school employee annually completes any training
required by the school nurse and school medical advisor in the
administra on of medica on with injectable equipment used to
administer glucagon;
(f) The school nurse and school medical advisor have a ested in
wri ng that selected school employee completed the required
training; and
(g) The selected school employee voluntarily agrees to serve as one
who may administer medica on with injectable equipment used
to administer glucagon to a student with diabetes that may
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 14 of 34
require prompt treatment in order to protect the student against
serious harm or death.
D. Epinephrine for Purposes of Emergency First Aid Without Prior Authoriza on
(1) For purposes of this Sec on D, “regular school hours” means the posted
hours during which students are required to be in a endance at the
individual school on any given day.
(2) The school nurse shall maintain epinephrine in cartridge injectors for the
purpose of emergency first aid to students who experience allergic
reac ons and do not have prior wri en authoriza on of a parent or
guardian or a prior wri en order of a qualified medical professional for
the administra on of epinephrine.
(a) The school nurse, in consulta on with the school nurse
supervisor, shall determine the supply of epinephrine in cartridge
injectors that shall be available in the individual school.
(b) In determining the appropriate supply of epinephrine in cartridge
injectors, the nurse may consider, among other things, the
number of students regularly in the school building during the
regular school day and the size of the physical building.
(3) The school nurse or school principal shall select principal(s), teacher(s),
licensed athle c trainer(s), licensed physical or occupa onal therapist(s)
employed by the Board, coach(es) and/or school paraprofessional(s) to
maintain and administer the epinephrine in cartridge injectors for the
purpose of emergency first aid as described in Paragraph (2) above, in the
absence of the school nurse.
(a) More than one individual must be selected by the school nurse or
school principal for such maintenance and administra on in the
absence of the school nurse.
(b) The selected personnel, before conduc ng such administra on,
must annually complete the training made available by the
Department of Educa on for the administra on of epinephrine in
cartridge injectors for the purpose of emergency first aid.
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 15 of 34
(c) The selected personnel must voluntarily agree to complete the
training and administer epinephrine in cartridge injectors for the
purpose of emergency first aid.
(4) Either the school nurse or, in the absence of the school nurse, at least
one of the selected and trained personnel as described in Paragraph (3)
above shall be on the grounds of each school during regular school hours.
(a) The school principal, in consulta on with the school nurse
supervisor, shall determine the level of nursing services and
number of selected and trained personnel necessary to ensure
that a nurse or selected and trained personnel is present on the
grounds of each school during regular school hours.
(b) If the school nurse, or a subs tute school nurse, is absent or must
leave school grounds during regular school hours, the school
nurse, school administrator or designee shall send an email to all
staff indica ng that the selected and trained personnel iden fied
in Paragraph (3) above shall be responsible for the emergency
administra on of epinephrine.
(5) The administra on of epinephrine pursuant to this sec on must be done
in accordance with this policy, including but not limited to the
requirements for documenta on and record keeping, errors in
medica on, emergency medical procedures, and the handling, storage
and disposal of medica on, and the Regula ons adopted by the
Department of Educa on.
(6) The parent or guardian of any student may submit, in wri ng, to the
school nurse or school medical advisor, if any, that epinephrine shall not
be administered to such student pursuant to this sec on.
(a) The school nurse shall no fy selected and trained personnel of
the students whose parents or guardians have refused emergency
administra on of epinephrine.
(b) The Board shall annually no fy parents or guardians of the need
to provide such wri en no ce.
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 16 of 34
(7) Following the emergency administra on of epinephrine by selected and
trained personnel as iden fied in this sec on:
(a) Such emergency administra on shall be reported immediately to:
(i) The school nurse or school medical advisor, if any, by the
personnel who administered the epinephrine; and
(ii) The student’s parent or guardian, by the school nurse or
personnel who administered the epinephrine.
(b) A medica on administra on record shall be:
(i) Submi ed to the school nurse by the personnel who
administered the epinephrine as soon as possible, but no
later than the next school day; and
(ii) filed in or summarized on the student’s cumula ve health
record, in accordance with Sec on E of this policy.
E. Naloxone for Purposes of Emergency First Aid
(1) Pursuant to a standing order of the Board’s medical advisor and authoriza on from
the Superintendent of Schools, and in accordance with Connec cut law and this
policy, a school nurse may maintain naloxone, for the purpose of administering
emergency first aid to students who experience a known or suspected opioid
overdose.
(a) The school nurse, in consulta on with the Board’s medical advisor, shall
determine the supply of naloxone that shall be maintained in the individual
school.
(b) The school nurse shall be responsible for the safe storage of naloxone
maintained in a school and shall ensure any supply of naloxone maintained is
stored in accordance with the manufacturer’s instruc ons.
(c) The school nurse shall be responsible for maintaining an inventory of naloxone
maintained in the school, tracking the date(s) of expira on of the supply of
naloxone maintained in a school, and, as appropriate, refreshing the supply of
naloxone maintained in the school.
(2) The school nurse, in consulta on with the Superintendent and the building principal,
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 17 of 34
shall provide no ce to parents and guardians of the Board’s policies and procedures
regarding the emergency administra on of naloxone in the event of a known or
suspected opioid overdose.
(3) A school nurse shall be approved to administer naloxone for the purpose of
emergency first aid, as described in Paragraph (1) above, in the event of a known or
suspected opioid overdose, provided that such nurse has completed appropriate
training, as iden fied by the Board’s medical advisor, which shall include training in
the iden fica on of opioid abuse and overdose.
(4) The administra on of naloxone pursuant to this sec on must be effected in
accordance with this policy and procedures regarding the acquisi on, maintenance,
and administra on established by the Superintendent in consulta on with the Board’s
medical advisor.
(5) Following the emergency administra on of naloxone by a school nurse:
(a) Such emergency administra on shall be reported immediately to:
(i) The Board medical advisor; and
(ii) The Superintendent; and
(iii) The student’s parent or guardian.
(b) A medica on administra on record shall be:
(i) Maintained by the school nurse who administered the naloxone as soon
as possible, but no later than the next school day; and
(ii) filed in or summarized on the student’s cumula ve health record, in
accordance with Sec on F of this policy.
F. Documenta on and Record Keeping
(1) Each school or before-and-a er school program and school readiness
program where medica ons are administered shall maintain an individual
medica on administra on record for each student who receives
medica on during school or program hours. This record shall include the
following informa on:
(a) the name of the student;
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 18 of 34
(b) the student’s state-assigned student iden fier (SASID);
(c) the name of the medica on;
(d) the dosage of the medica on;
(e) the route of the administra on,
(i.e. oral, topical, inhalant, etc.);
(f) the frequency of administra on;
(g) the name of the authorized prescriber;
(h) the dates for ini a ng and termina ng the administra on of
medica on, including extended-year programs;
(i) the quan ty received at school and verifica on by the adult
delivering the medica on of the quan ty received;
(j) the date the medica on is to be reordered (if any);
(k) any student allergies to food and/or medica on(s);
(l) the date and me of each administra on or omission, including
the reason for any omission;
(m) the dose or amount of each medica on administered;
(n) the full wri en or electronic legal signature of the nurse or other
authorized school personnel administering the medica on; and
(o) for controlled medica ons, a medica on count which should be
conducted and documented at least once a week and co-signed
by the assigned nurse and a witness.
(2) All records are either to be made in ink and shall not be altered, or
recorded electronically in a record that cannot be altered.
(3) Wri en orders of authorized prescribers, wri en authoriza ons of parent
or guardian, the wri en parental permission for the exchange of
informa on by the prescriber and school nurse to ensure safe
administra on of such medica on, and the completed medica on
administra on record for each student shall be filed in the student's
cumula ve health record or, for before-and-a er school programs and
school readiness programs, in the child’s program record.
(4) Authorized prescribers may make verbal orders, including telephone
orders, for a change in medica on order. Such verbal orders may be
received only by a school nurse and must be followed by a wri en order,
which may be faxed, and must be received within three (3) school days.
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 19 of 34
(5) Medica on administra on records will be made available to the
Department of Educa on for review un l destroyed pursuant to Sec on
11-8a and Sec on 10-212a(b) of the Connec cut General Statutes.
(a) The completed medica on administra on record for non-
controlled medica ons may, at the discre on of the school
district, be destroyed in accordance with Sec on M8 of the
Connec cut Record Reten on Schedules for Municipali es, so
long as it is superseded by a summary on the student health
record.
(b) The completed medica on administra on record for controlled
medica ons shall be maintained in the same manner as the non-
controlled medica ons. In addi on, a separate medica on
administra on record needs to be maintained in the school for
three (3) years pursuant to Sec on 10-212a(b) of the Connec cut
General Statutes.
(6) Documenta on of any administra on of medica on by a coach or
licensed athle c trainer shall be completed on forms provided by the
school and the following procedures shall be followed:
(a) a medica on administra on record for each student shall be
maintained in the athle c offices;
(b) administra on of a cartridge injector medica on shall be reported
to the school nurse at the earliest possible me, but no later than
the next school day;
(c) all instances of medica on administra on, except for the
administra on of cartridge injector medica on, shall be reported
to the school nurse at least monthly, or as frequently as required
by the individual student plan; and
(d) the administra on of medica on record must be submi ed to the
school nurse at the end of each sport season and filed in the
student’s cumula ve health record.
G. Errors In Medica on Administra on
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 20 of 34
(1) Whenever any error in medica on administra on occurs, the following
procedures shall apply:
(a) the person making the error in medica on administra on shall
immediately implement the medica on emergency procedures in
this Policy if necessary;
(b) the person making the error in medica on administra on shall in
all cases immediately no fy the school nurse, principal, school
nurse supervisor, and authorized prescriber. The person making
the error, in conjunc on with the principal, shall also immediately
no fy the parent or guardian, advising of the nature of the error
and all steps taken or being taken to rec fy the error, including
contact with the authorized prescriber and/or any other medical
ac on(s); and
(c) the principal shall no fy the Superintendent or the
Superintendent's designee.
(2) The school nurse, along with the person making the error, shall complete
a report using the authorized medica on error report form. The report
shall include any correc ve ac on taken.
(3) Any error in the administra on of medica on shall be documented in the
student's cumula ve health record or, for before-and-a er school
programs and school readiness programs, in the child’s program record.
(4) These same procedures shall apply to coaches and licensed athle c
trainers during intramural and interscholas c events, except that if the
school nurse is not available, a report must be submi ed by the coach or
licensed athle c trainer to the school nurse the next school day.
H. Medica on Emergency Procedures
(1) Whenever a student has a life-threatening reac on to administra on of a
medica on, resolu on of the reac on to protect the student's health and
safety shall be the foremost priority. The school nurse and the
authorized prescriber shall be no fied immediately, or as soon as
possible in light of any emergency medical care that must be given to the
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 21 of 34
student.
(2) Emergency medical care to resolve a medica on emergency includes but
is not limited to the following, as appropriate under the circumstances:
(a) use of the 911 emergency response system;
(b) applica on by properly trained and/or cer fied personnel of
appropriate emergency medical care techniques, such as cardio-
pulmonary resuscita on;
(c) administra on of emergency medica on in accordance with this
policy;
(d) contact with a poison control center; and
(e) transpor ng the student to the nearest available emergency
medical care facility that is capable of responding to a medica on
emergency.
(3) As soon as possible, in light of the circumstances, the principal shall be
no fied of the medica on emergency. The principal shall immediately
therea er contact the Superintendent or the Superintendent's designee,
who shall therea er no fy the parent or guardian, advising of the
existence and nature of the medica on emergency and all steps taken or
being taken to resolve the emergency and protect the health and safety
of the student, including contact with the authorized prescriber and/or
any other medical ac on(s) that are being or have been taken.
I. Supervision
(1) The school nurse is responsible for general supervision of administra on
of medica ons in the school(s) to which that nurse is assigned.
(2) The school nurse's duty of general supervision includes, but is not limited
to, the following:
(a) availability on a regularly scheduled basis to:
(i) review orders or changes in orders and communicate
these to personnel designated to give medica on for
appropriate follow-up;
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 22 of 34
(ii) set up a plan and schedule to ensure medica ons are
given properly;
(iii) provide training to licensed nursing personnel, full- me
principals, full- me teachers, full- me licensed physical or
occupa onal therapists employed by the school district,
coaches of intramural and interscholas c athle cs,
licensed athle c trainers and iden fied paraprofessionals
designated in accordance with Sec on B(3)(g), above,
which training shall pertain to the administra on of
medica ons to students, and assess the competency of
these individuals to administer medica on;
(iv) support and assist other licensed nursing personnel, full-
me principals, full- me teachers, full- me licensed
physical or occupa onal therapists employed by the school
district, coaches of intramural and/or interscholas c
athle cs, licensed athle c trainers and iden fied
paraprofessionals designated in accordance with Sec on
B(3)(g), above, to prepare for and implement their
responsibili es related to the administra on of specific
medica ons during school hours and during intramural
and interscholas c athle cs as provided by this policy;
(v) provide appropriate follow-up to ensure the
administra on of medica on plan results in desired
student outcomes, including providing proper no fica on
to appropriate employees or contractors regarding the
contents of such medical plans; and
(vi) provide consulta on by telephone or other means of
telecommunica ons, which consulta on may be provided
by an authorized prescriber or other nurse in the absence
of the school nurse.
(b) In addi on, the school nurse shall be responsible for:
(i) implemen ng policies and procedures regarding the
receipt, storage, and administra on of medica ons;
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 23 of 34
(ii) reviewing, on a periodic basis, all documenta on
pertaining to the administra on of medica ons for
students;
(iii) performing observa ons of the competency of medica on
administra on by full- me principals, full- me teachers,
full- me licensed physical or occupa onal therapists
employed by the school district, coaches of intramural
and/or interscholas c athle cs and licensed athle c
trainers in accordance with Sec on B(3)(f), above, and
iden fied paraprofessionals designated in accordance with
Sec on B(3)(g), above, who have been newly trained to
administer medica ons; and,
(iv) conduc ng periodic reviews, as needed, with licensed
nursing personnel, full- me principals, full- me teachers,
full- me licensed physical or occupa onal therapists
employed by the school district, coaches of intramural
and/or interscholas c athle cs and licensed athle c
trainers in accordance with Sec on B(3(f), above, and
iden fied paraprofessionals designated in accordance with
Sec on B(3)(g), above, regarding the needs of any student
receiving medica on.
J. Training of School Personnel
(1) Full- me principals, full- me teachers, full- me licensed physical or
occupa onal therapists employed by the school district, coaches of
intramural and/or interscholas c athle cs and licensed athle c trainers
in accordance with Sec on B(3)(f), above, and iden fied
paraprofessionals designated in accordance with Sec on B(3)(g), above,
who are designated to administer medica ons shall at least annually
receive training in their safe administra on, and only trained full- me
principals, full- me teachers, full- me licensed physical or occupa onal
therapists employed by the school district, coaches of intramural and/or
interscholas c athle cs and licensed athle c trainers in accordance with
Sec on B(3) (f), above, and iden fied paraprofessionals designated in
accordance with Sec on B(3)(g), above, shall be allowed to administer
medica ons.
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 24 of 34
(2) Training for full- me principals, full- me teachers, full- me licensed
physical or occupa onal therapists employed by the school district,
coaches of intramural and/or interscholas c athle cs and licensed
athle c trainers in accordance with Sec on B(3)(f), above, and iden fied
paraprofessionals designated in accordance with Sec on B(3)(g), above,
shall include, but is not necessarily limited to, the following:
(a) the general principles of safe administra on of medica on;
(b) the procedures for administra on of medica ons, including the
safe handling and storage of medica ons, and the required
record-keeping; and
(c) specific informa on related to each student’s medica on plan,
including the name and generic name of the medica on,
indica ons for medica on dosage, routes, me and frequency of
administra on, therapeu c effects of the medica on, poten al
side effects, overdose or missed doses of the medica on, and
when to implement emergency interven ons.
(3) The principal(s), teacher(s), licensed athle c trainer(s), licensed physical
or occupa onal therapist(s) employed by the Board, coach(es) and/or
school paraprofessional(s) who administer epinephrine as emergency
first aid, pursuant to Sec on D above, shall annually complete the
training program developed by the Departments of Educa on and Public
Health and training in cardiopulmonary resuscita on and first aid.
(4) The Board shall maintain documenta on of medica on administra on
training as follows:
(a) dates of general and student-specific trainings;
(b) content of the trainings;
(c) individuals who have successfully completed general and student-
specific administra on of medica on training for the current
school year; and
(d) names and creden als of the nurse or school medical advisor, if
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 25 of 34
any, trainer or trainers.
(5) Licensed prac cal nurses may not conduct training in the administra on
of medica on to another individual.
K. Handling, Storage and Disposal of Medica ons
(1) All medica ons, except those approved for transpor ng by students for
self-medica on, those administered by coaches of intramural or
interscholas c athle cs or licensed athle c trainers in accordance with
Sec on B(3)(f) above, and epinephrine or naloxone to be used for
emergency first aid in accordance with Sec ons D and E above, must be
delivered by the parent, guardian, or other responsible adult to the nurse
assigned to the student's school or, in the absence of such nurse, the
school principal who has been trained in the appropriate administra on
of medica on. Medica ons administered by coaches of intramural or
interscholas c athle cs or licensed athle c trainers must be delivered by
the parent or guardian directly to the coach or licensed athle c trainer in
accordance with Sec on B(3)(f)above.
(2) The nurse shall examine on-site any new medica on, medica on order
and the required authoriza on to administer form, and, except for
epinephrine and naloxone to be used as emergency first aid in
accordance with Sec ons D and E above, shall develop a medica on
administra on plan for the student before any medica on is given to the
student by any school personnel. No medica on shall be stored at a
school without a current wri en order from an authorized prescriber.
(3) The school nurse shall review all medica on refills with the medica on
order and parent authoriza on prior to the administra on of medica on,
except for epinephrine and naloxone intended for emergency first aid in
accordance with Sec ons D and E above.
(4) Emergency Medica ons
(a) Except as otherwise determined by a student’s emergency care
plan, emergency medica ons shall be stored in an unlocked,
clearly labeled and readily accessible cabinet or container in the
health room during school hours under the general supervision of
the school nurse or, in the absence of the school nurse, the
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 26 of 34
principal or the principal’s designee who has been trained in the
administra on of medica on.
(b) Emergency medica on shall be locked beyond the regular school
day or program hours, except as otherwise determined by a
student’s emergency care plan.
(5) All medica ons, except those approved for keeping by students for self-
medica on, shall be kept in a designated and locked loca on used
exclusively for the storage of medica on. Controlled substances shall be
stored separately from other drugs and substances in a separate, secure,
substan ally constructed, locked metal or wood cabinet.
(6) Access to stored medica ons shall be limited to persons authorized to
administer medica ons. Each school or before-and-a er school program
and school readiness program shall maintain a current list of such
authorized persons.
(7) All medica ons, prescrip on and non-prescrip on, shall be delivered and
stored in their original containers and in such a manner that renders
them safe and effec ve.
(8) At least two sets of keys for the medica on containers or cabinets shall
be maintained for each school building or before-and-a er school
program and school readiness program. One set of keys shall be
maintained under the direct control of the school nurse or nurses and an
addi onal set shall be under the direct control of the principal and, if
necessary, the program director or lead teacher who has been trained in
the general principles of the administra on of medica on shall also have
a set of keys.
(9) Medica ons that must be refrigerated shall be stored in a refrigerator at
no less than 36 degrees Fahrenheit and no more than 46 degrees
Fahrenheit. The refrigerator must be located in the health office that is
maintained for health services with limited access. Non-controlled
medica ons may be stored directly on the refrigerator shelf with no
further protec on needed. Controlled medica on shall be stored in a
locked box that is affixed to the refrigerator shelf.
(10) All unused, discon nued or obsolete medica ons shall be removed from
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 27 of 34
storage areas and either returned to the parent or guardian or, if the
medica on cannot be returned to the parent or guardian, the medica on
shall be destroyed in collabora on with the school nurse:
(a) non-controlled drugs shall be destroyed in the presence of at least
one witness;
(b) controlled drugs shall be destroyed in pursuant to Sec on 21a-
262-3 of the Regula ons of Connec cut State Agencies; and
(c) accidental destruc on or loss of controlled drugs must be verified
in the presence of a second person, including confirma on of the
presence or absence of residue, and jointly documented on the
student medica on administra on record and on a medica on
error form pursuant to Sec on 10-212a(b) of the Connec cut
General Statutes. If no residue is present, no fica on must be
made to the Department of Consumer Protec on pursuant to
Sec on 21a-262-3 of the Regula ons of Connec cut State
Agencies.
(11) Medica ons to be administered by coaches of intramural or
interscholas c athle c events or licensed athle c trainers shall be stored:
(a) in containers for the exclusive use of holding medica ons;
(b) in loca ons that preserve the integrity of the medica on;
(c) under the general supervision of the coach or licensed athle c
trainer trained in the administra on of medica on; and
(d) in a locked secured cabinet when not under the general
supervision of the coach or licensed athle c trainer during
intramural or interscholas c athle c events.
(12) In no event shall a school store more than a three (3) month supply of a
medica on for a student.
L. School Readiness Programs and Before-and-A er School Programs
(1) As determined by the school medical advisor, if any, and school nurse
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 28 of 34
supervisor, the following procedures shall apply to the administra on of
medica on during school readiness programs and before-and-a er
school programs run by the Board, which are exempt from licensure by
the Office of Early Childhood:
(a) Administra on of medica on at these programs shall be provided
only when it is medically necessary for par cipants to access the
program and maintain their health status while a ending the
program.
(b) Except as provided by Sec ons D and E above, no medica on shall
be administered in these programs without:
(i) the wri en order of an authorized prescriber; and
(ii) the wri en authoriza on of a parent or guardian or an
eligible student.
(c) A school nurse shall provide consulta on to the program director,
lead teacher or school administrator who has been trained in the
administra on of medica on regarding the safe administra on of
medica on within these programs. The school medical advisor
and school nurse supervisor shall determine whether, based on
the popula on of the school readiness program and/or before-
and-a er school program, addi onal nursing services are required
for these programs.
(d) Only school nurses, directors or directors’ designees, lead
teachers or school administrators who have been properly trained
may administer medica ons to students as delegated by the
school nurse or other registered nurse. Properly trained directors
or directors’ designees, lead teachers or school administrators
may administer oral, topical, intranasal or inhalant medica ons.
Inves ga onal drugs or research or study medica ons may not be
administered in these programs.
(e) Students a ending these programs may be permi ed to self-
medicate only in accordance with the provisions of Sec on B(3) of
this policy. In such a case, the school nurse must provide the
program director, lead teacher or school administrator running
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 29 of 34
the program with the medica on order and parent permission for
self-administra on.
(f) In the absence of the school nurse during program administra on,
the program director, lead teacher or school administrator is
responsible for decision-making regarding medica on
administra on.
(g) Cartridge injector medica ons may be administered by a director,
lead teacher or school administrator only to a student with a
medically-diagnosed allergic condi on which may require prompt
treatment to protect the student against serious harm or death.
(2) Local poison control center informa on shall be readily available at these
programs.
(3) Procedures for medica on emergencies or medica on errors, as outlined
in this policy, must be followed, except that in the event of a medica on
error a report must be submi ed by the program director, lead teacher
or school administrator to the school nurse the next school day.
(4) Training for directors or directors’ designees, lead teachers or school
administrators in the administra on of medica on shall be provided in
accordance with Sec on IJ of this policy.
(5) All medica ons must be handled and stored in accordance with Sec on K
of this policy. Where possible, a separate supply of medica on shall be
stored at the site of the before-and-a er or school readiness program. In
the event that it is not possible for the parent or guardian to provide a
separate supply of medica on, then a plan shall be in place to ensure the
mely transfer of the medica on from the school to the program and
back on a daily basis.
(6) Documenta on of any administra on of medica on shall be completed
on forms provided by the school and the following procedures shall be
followed:
(a) a medica on administra on record for each student shall be
maintained by the program;
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 30 of 34
(b) administra on of a cartridge injector medica on shall be reported
to the school nurse at the earliest possible me, but no later than
the next school day;
(c) all instances of medica on administra on, except for the
administra on of cartridge injector medica on, shall be reported
to the school nurse at least monthly, or as frequently as required
by the individual student plan; and
(d) the administra on of medica on record must be submi ed to the
school nurse at the end of each school year and filed in the
student’s cumula ve health record.
(7) The procedures for the administra on of medica on at school readiness
programs and before-and-a er school programs shall be reviewed
annually by the school medical advisor, if any, and school nurse
supervisor.
M. Review and Revision of Policy
In accordance with the provisions of Conn. Gen. Stat. Sec on 10-212a(a)(2), the
Board shall review this policy periodically, and at least biennially, with the advice and
approval of the school medical advisor, if any, or other qualified licensed physician, and
the school nurse supervisor. Any proposed revisions to the policy must be made with
the advice and approval of the school medical advisor, school nurse supervisor or other
qualified licensed physician.
Legal References: Connec cut
General Statutes:
Sec on 10-206
Sec on 10-212
Sec on 10-212a
Sec on 10-220j
Sec on 19a-900
Sec on 21a-240
Sec on 52-557b
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 31 of 34
Public Act 18-185, “An Act Concerning the Recommenda ons of the Task Force on Life-
Threatening Food Allergies in Schools”
Regula ons of Conn. State Agencies:
Sec ons 10-212a-1 through 10-212a-10, inclusive
Memorandum of Decision, In Re: Declaratory Ruling/Delega on by Licensed Nurses to
Unlicensed Assis ve Personnel, Connec cut State Board of Examiners for
Nursing (April 5, 1995)
ADOPTED: August 26, 2015
REVISED: November 13, 2018
238944v32
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 32 of 34
Colchester Public Schools
127 Norwich Avenue, Suite 202
Colchester, CT 06415
Jeffrey E. Burt Phone (860) 537-7208
Superintendent of Schools jburt@colchesterct.org
REFUSAL TO PERMIT ADMINISTRATION OF EPINEPHRINE FOR EMERGENCY FIRST AID
Name of Child: Date of Birth:
Address of Child:
Name of Parent(s):
Address of Parent(s):
(if different from child)
Connec cut law requires the school nurse and other qualified school personnel in all public
schools to maintain epinephrine in cartridge injectors (EpiPens) for the purpose of
administering emergency first aid to students who experience allergic reac ons and do not
have a prior wri en authoriza on of a parent or guardian or a prior wri en order of a qualified
medical professional for the administra on of epinephrine. State law permits the parent or
guardian of a student to submit a wri en direc ve to the school nurse or school medical
advisor that epinephrine shall not be administered to such student in emergency situa ons.
This form is provided for those parents who refuse to have epinephrine administered to their
child. The refusal is valid for only for the current school year.
I, , the parent/guardian of ,
refuse to permit the administra on of epinephrine to the above named student for purposes of
emergency first aid in the case of an allergic reac on.
Signature of Parent/Guardian Date
Please return the completed original form to your child’s school nurse.
2/2022
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 33 of 34
Colchester Public Schools
127 Norwich Avenue, Suite 202
Colchester, CT 06415
Jeffrey E. Burt Phone (860) 537-7208
Superintendent of Schools jburt@colchesterct.org
REFUSAL TO PERMIT ADMINISTRATION OF NALOXONE FOR EMERGENCY FIRST AID
Name of Child: Date of Birth:
Address of Child:
Name of Parent(s):
Address of Parent(s):
(if different from child)
Per Board Policy 5141.21 Administra on of Medica on, the school nurse and other qualified
school personnel in Colchester Public Schools will maintain Naloxone (Narcan) for the
purpose of administering emergency first aid to students who experience life-threatening
adverse events related to drug use. Colchester Public Schools permits the parent or guardian
of a student to submit a wri en direc ve to the school nurse or school medical advisor that
Naloxone shall not be administered to such student in emergency situa ons. This form is
provided for those parents who refuse to have Naloxone administered to their child. The
refusal is valid for only for the current school year.
I, , the parent/guardian of ,
refuse to permit the administra on of Naloxone (Narcan) to the above named student for
purposes of emergency first aid in the case of an life-threatening adverse event related to
drug use.
Signature of Parent/Guardian Date
Please return the completed original form to your child’s school nurse.
2/2022
ADMINISTRATION OF STUDENT MEDICATIONS IN THE SCHOOLS Page 34 of 34