Desoto Independent School District

. DeSoto Independent School District Health Services

The DeSoto Independent School district requires that all students who need non- prescription medication during school hours bring the medication in the original bottle to the clinic. The medication will only be given if there is written parent permission on file in the school clinic.

One-a-day, twice-a-day, and three-a-day medication should be given at home.

Student Name:______Date of Birth:______

Grade:______School: Woodridge Fine Arts Magnet Academy

PERMISSION FOR NON-PRESCRIPTION MEDICATION

I give permission for my child to receive the following non-prescription medication. I understand this can be requested for five (5) school days.

Name of Medication: ______

Dose to be given at school: ______

(This must coincide with the label directions.)

Time to be given at school: ______

Reason for medication: ______

______

(Date) Parent/Guardian Signature

Work phone: ______

Home phone: ______