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Medication Administration

School's Responsibility in the Administration of Medication

1. ALL MEDICATION TO BE DELIVERED TO SCHOOL BY AN ADULT, INCLUDING OVER-THE-COUNTER MEDICATIONS. Prescribed medications must be in the pharmacy bottle and labeled with the licensed prescriber’s name, date, name of the medication, and instructions for administration. Over the counter medications must be in the original manufacturer labeled container.


      A.  Pharmacy bottle

      B.  Parental permission slip

      C.   M.D. order

3. Unless otherwise approved, the school nurse shall be responsible for the management and distribution of all medications to students in the Pembroke Schools in accordance with the regulations of 105 CMR 210.000 and MGL Chapter 94. Exceptions would include the possession and self-administration of any prescribed medications for asthma, related respiratory diseases, cystic fibrosis and diabetes as specified in MGL Chapter 71.Section 54B.

4.  The Pembroke School District “Medical Consent and Information” page is to be updated and signed annually.  The parent/guardian may grant permission on this page for the school nurse to administer Tylenol, Motrin, Benadryl, and antacids.

EpiPens and Life-threatening Allergies

EpiPens and Life-threatening Allergies

It is expected that all high school students who have been prescribed Epinephrine (EpiPen, AuviQ), carry their Epinephrine with them during the school day and extracurricular activities. A note signed by the student’s healthcare provider should be submitted to the school nurse if a student no longer requires an EpiPen.

Pembroke Medication Forms

Medical Administration Plan (All Schools)