Medical Forms
Medications at School
If your child must take medication at school, the following procedures are District Health Services requirements from the Colorado Health Department and they are mandatory. We cannot make any exceptions on this policy.
Medication of any kind (prescription or non-prescription/over the counter) is to be brought into the office by a parent in its ORIGINAL CONTAINER.
Parents must sign the district form for dispensing medication. If the medication is prescribed by a health care provider then both the parent and the physician must sign the form. Prescription medication must have the child’s name on it and the pharmacy labeled container suffices for the physician’s signature if the medication is to be given under fourteen days.
The district form for dispensing medication can be obtained from the school website, health room aide or secretary.
We cannot dispense any medication unless a district form is completed and on file in the health room.
Students are NOT to carry any medication with them to school, at school, or from school to home. Medications may only be brought to school and picked up from school by a parent/guardian. Medication of any kind brought to school in baggies, envelopes, etc. will not be accepted. Any medication not picked up by the end of the school year will be disposed of according to District Health Services Guidelines.
Immunizations at School
Immunization requirements will be strictly enforced for all students. Per Colorado Law all students enrolled in a Colorado Public School must have a minimum number of required immunizations or submit a completed personal or religious exemption ANNUALLY to the school health aide in order to begin school. Additional information on immunization requirements along with exemption forms can be found on the Jeffco Public Schools website under Health Services. Please contact the Health Aide for current immunization requirements. Students who do not meet these requirements will be denied attendance according to Colorado Revised Statutes 25-4-902.
Medical Forms in Jeffco
Families must complete the required forms and have them signed by their healthcare provider if their student has a condition that requires the administration of any medication during the school day.
To fill out any of the forms below:
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Click on the form link.
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Download the form.
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Print the form.
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Fill out the form.
Medication Forms
Families must provide a Medication Agreement form, completed and signed by their healthcare provider if their student has a condition that requires the administration of any medication during the school day. This includes over-the-counter and prescription medications.
Families will provide medication in the original packaged or prescription container that has not expired with the signed medication form below. Once received, a nurse may delegate administration of a prescription or over-the-counter medication, based on the health care provider's order.
According to Board Policy JLC - Student Health Services and Requirements and Colorado Nursing Board Policy #30-04, district nurses must call physicians to verify orders if needed.
Medication agreement form
Medication Agreement (English) Acuerdo de medicación (Spanish) Разрешение на выдачу лекарств (Russian)
Extended field trip medication forms
One of the following forms must be completed for any overnight field trip.
CO State Asthma Care Plan
Students who require an inhaler or medication for asthma need their healthcare provider and families to complete the Colorado Asthma Care Plan and return it to the school health aide with the medication.
This form replaces the medication agreement form. Families of students with asthma or health concerns are encouraged to contact their District Registered Nurse (RN) to follow up regarding care and support at school.
CO State Allergy Care Plan
Many students have potentially life-threatening food allergies. To address this issue and meet state law requirements concerning managing food allergies and anaphylaxis among students, the Board has established Policy JLCDA. This policy specifies details about a health care plan, reasonable accommodations, access to emergency medications and staff training.
Families, the school administrator, and the District RN will develop a health plan using the Colorado Allergy and Anaphylaxis Care Plan, which you can have your care provider complete and return to the school. This form replaces the above medication agreement form.
CO State Seizure Care Plan
In 2021, the Colorado General Assembly passed HB-21-113 to prioritize school safety for students who have a seizure disorder, including epilepsy. This bill addresses strategic resources for kindergarten through 12th-grade schools to provide a safer environment for these students, including school personnel training, individualized seizure action plans and seizure care guidelines.
Your District RN will work with you to develop a health plan using the Colorado Seizure Care Plan which you can have your provider complete and return to the school. This form replaces the above medication agreement form.