HIGH SCHOOL OTC MEDICATION AUTHORIZATIONAdministrationFaculty & StaffWelcomeMission & VisionCulture of LifeSpiritual LifeEmploymentDiocese of ArlingtonAppendix F-6A The Following FOrm must be completedby Parent/GuardianHigh School OTC Medication Authorization: Release and Indemnification Agreement This form is to be used for clinic stocked over-the-counter (OTC) medications onlyStudent Name (Last, Middle, First)(Required)Date of Birth(Required)Drug Allergies(Required)School(Required)School Year (You must fill out a new form each year)(Required)Occasionally, you child may unexpectedly need medicine during a school day. For those occasions, the school clinic stocks a limited number of over the counter medications which the school nurse may administer with your written permission. The school nurse will assess your child and pertinent comfort measures may be utilized before medication is administered. Only the school nurse or her licensed designee may administer the OTC medications, based on nursing judgment and as instructed on the medication label. Please select the nonprescription medications that the school nurse has permission to administer:(Required) Ibuprofen 2 (200mg) tablets to reduce inflammations/fever (equivalent to Motrin/Advil) Acetaminophen 2 (325mg) tablets to reduce pain/fever (equivalent to Tylenol) TUMS (antacid) for minor upset stomach Cough drops (cherry flavored/menthol drops)Select AllParent Signature(Required)Daytime Phone(Required)Δ Saint Michael the Archangel Catholic High School6301 Campus Dr, Fredericksburg, VA 22407(540) 548-8748Quick Links> Admissions > Academics > Staff > Contact UsSupport Us Donate