Medical Forms

These forms are required at the beginning of every school year for those students who:

  1. Need medication administered during school hours
  2. Have allergies and therefore need an anaphylaxis plan
  3. Have a medical condition
  4. Have a medical condition AND may require emergency medication
  5. Have diabetes and therefore need a diabetes management plan

Please fill out the appropriate form(s) and forward to your child’s homeroom teacher. If you have any questions, please contact one of our guidance counsellors; deboramoores@nlesd.ca or mandyward@nlesd.ca. 

Please see the links below for the forms for specific medical needs.

1. Students requiring medication administered at school during school hours.

Form 301 Administration of Medication

  • Form 301 must be submitted and contain parent and physician signature before any medication can be administered to the student. The form must be updated annually and/or when changes are made to the student’s medication.
  • Instructions and arrangements pertinent to the nature and administration of the medication must be clearly outlined by the prescribing physician on Form 301-A: Administration of Medications.
  • Prescribed medications in the original container must be delivered to the school by the parent/guardian or designated adult representative and given to the school administrator or designate. The container in which the medication is kept must have an attached label showing at least the following:
    • Name of the prescribing physician;
    • Name of student;
    • Date prescribed;
    • Dosage and times for administering; and
    • Expiry date of the prescription.
    • It is recommended that, when a container is received, the dosages to be given at school/during school hours be highlighted on the label.
  • Parents/guardians are to provide to the school any additional information from the physician or pharmacist regarding storage, possible side effects, instructions on emergency procedures in the event of a reaction to the medication, etc.
  • Parents/guardians must provide emergency contact telephone numbers. In the event of an emergency, if no contact can be made with the parent/guardian or an emergency contact, then ‘Good Samaritan’ action may occur.

2. Students with allergies requiring medical support for Anaphylaxis:

Anaphylaxis Alert form

Anaphylaxis Emergency plan

Form 301 Administration of Medication

3. Students requiring a school medical plan for medical conditions :

4. Students requiring a school medical plan for medical conditions  AND administration of emergency medications :

Form 301 Administration of Medication

5. Students requiring Diabetes Management/Emergency Plan and administration of emergency medications :

Diabetes Management in Schools form

Form 301 Administration of Medication