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Parents: Note that while you can fill out these forms on your computer, you need to print them and send them in. Just saving the filled-out form on your computer doesn't transmit the information back to us.

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Attached is a permission form for emergency medical treatment. It will be kept on file with the school nurse. ALL PARENTS MUST COMPLETE THIS FORM AND RETURN IT TO THEIR SON’S TEACHERS OR THE SCHOOL NURSE AS SOON AS POSSIBLE. This will ensure the safety and well-being of your son in case of illness or injury.


In order to better serve PDS students who must take medications during the school day, please assist us by following these guidelines which are recommended by the American Academy of Pediatrics Committee on School Health and the Memphis and Shelby County Health Department:

  1. PDS parents must complete the authorization forms that are available on the PDS website.

  2. Parents must bring the medication to the office. Children are not allowed to transport medication. The medication should be provided to the school in the original container labeled by the pharmacist. This label must include patient’s name, name of the drug, dosage, how often taken and reason for the medication. This label will serve as the doctor’s order. The medication will be kept in a locked space in the school nurse office. The school nurse will keep a record (date and time) of all medication administered.

  3. If a child is given a prescription to be taken “three times daily,” it is recommended that the parent give it to him before he comes to school, after going home from school, and before bedtime. The school will give medication only when dispensing is ordered more often or with lunch.

  4. It is the responsibility of the parents to get refills when the bottle is sent home.

Over the Counter Medications

PDS provides some over-the-counter medications, such as Turns, cough drops, and topical medications. Attached is a permission form for usage of these medications. The student will not be given any of these medications unless a permission form is filled out and on file in the nurses’ office.

A separate form is required for oral, over-the-counter medications such as Tylenol, Advil, Motrin, Benadryl, cough syrup, etc. If you would like your son to be given any of these medications you must bring the medication in the original bottle labeled with the student’s name and grade along with a completed permission form. This form may be picked up in the nurses’ office.

To ensure the safety and well-being of all PDS students, parents are requested to follow these important guidelines. If you have any questions or concerns regarding circumstances, please feel free to call the school nurse at 842-4627.

Sincerely,
icon_email Dale Hill, R.N., B.S.N.

Download the forms:
pdf2012-Parent_Provided_Medications.pdf104.13 KB
pdf2012-Authorization_for_Prescription_Medications_2012-13.pdf99.06 KB
pdf2012-Emergency_Medical_Treatment_2012-13.pdf102.03 KB
pdf2012-School_Provided_OTC_Medication.pdf105.11 KB