2nd Grade to 6th Grade

11/28/2020

PATERSON CHARTER SCHOOL

FOR SCIENCE AND TECHNOLOGY 2-6

PATERSON CHARTER SCHOOL

FOR SCIENCE AND TECHNOLOGY 2-6

Physician Order Form

PHYSICIAN ORDER FORM
 
A physician order form only needs to be completed anytime your child requires medications during school hours. This includes over the counter (tylenol, motrin, cough syrup, cough drops, stomach medication, creams sunscreen, etc.) and prescription medications (antibiotics, creams, cough syrup, Epi Pen, allergy medications, asthma medications, etc.). 
 
Medication may NOT be administered by the school nurse unless this form is completed in its entirety, signed, and stamped by a doctor AND is signed by the parent as well. If the doctor completes the form and the parent does not sign, the medication may not be administered. If the parent signs the form but the doctor does not sign, the medication may still not be administered. BOTH signatures are required for the school nurse to administer medications*
*For Epi Pen and Benadryl orders, please refer to the Epinephrine Permission and Physician Order Form page. This form does not need to be completed for those specific medications.
*For asthma medications (inhalers/nebulizers), please refer to the Asthma Action Plan Form page.This form does not need to be completed for those specific medications. 
 
Download link is at the bottom of the page.

PCSST is an equal opportunity provider.