Medication Authorization Information & Forms

  • Medical treatment is the responsibility of the parent/guardian and an authorized health care provider. An authorized health care provider is an individual who is licensed by the State of California to prescribe medication. Medications, both prescription and over the counter, may be given at school when it is deemed absolutely necessary by the authorized health care provider that the medication be given during school hours. The parent/legal guardian is urged, with the help of your child’s authorized health care provider, to work out a schedule of giving medication at home whenever possible.

    California Education Code, Section 49423 allows school personnel to assist in carrying out an authorized health care provider’s written orders and instructions. Designated non-medical school personnel may be administering your child’s medication. They will be trained and supervised by credentialed school nurses. Medication will be safely stored and locked or refrigerated, if required. Emergency medication such as auto-injectable epinephrine or asthma inhalers may be carried by the student when recommended by an authorized health care provider and approved by a parent or legal guardian.

    When appropriate, the school nurse will evaluate the student’s ability to safely self-administer the medication. Back up medication should be kept at school for emergency use. Students who have a serious medical condition (diabetes, epilepsy, severe food or environmental allergy, etc.) should have an emergency supply of their prescription medication at school with the appropriate consent forms in the event of a disaster. These students should also have a health plan on file. If your child does not have a health plan, please contact the health office at your child’s school.


    1. A written statement signed by the licensed authorized health care provider specifying the reason for the medication, the name, dosage, time, route, side effects, and specific instructions for emergency treatment must be on file at school. A signed request from the parent/legal guardian must also be on file. One form per medication for each school year is required. A new form is required if there are any changes in medication or provider.

    Please click on the link below to download this form. Have your child’s health care provider fill it out and sign the health care provider section. Once completed, return the form to your school office.

    Medical Authorization Form (English)

    Medical Authorization Form (Spanish)

    2. Medication must be delivered to the school by the parent/legal guardian or other responsible adult.

    3. Medication must be in your child’s original, labeled pharmacy container. Over the counter medications must also be in their original container.

    4. Liquid medications must be accompanied by an appropriate measuring device.

    5. Any tablets requiring partial doses (ex. Cut in ½) must be sent to school already cut.

    Please also follow the instructions listed below:

    Discuss your authorized health care provider’s instructions with your child, so that he/she is aware of the time medication is due at school.

    Discuss with your child your authorized health care provider’s instructions regarding the proper usage of an emergency inhaler/auto-injectable epinephrine device that he/she is authorized to self-carry and administer.

    Arrange with the school to pick up leftover medication on the last day of the school year. Medication(s) left at school after the end of the school year will be discarded.

    For any questions or concerns, please contact the health aide at your child’s school at the number 626-599-5106 or by email to