Health Info (incl Forms)

A Message From Dunstan's District RN:

All medications in the school setting, including self-carry, must be accompanied by a provider’s order with prescriptive rights with the following information:

  • Student’s name
  • Date of birth
  • Medication (cannot be expired and if prescribed, must include pharmacy label)
  • Reason for medication
  • Dosage (cannot include ranges)
  • Route (how the medication will be given)
  • Time (must be a specific time or as needed)
  • Parent/guardian signature
  • Provider signature

Any medications found without proper documentation will be removed and the parent/guardian will be notified to pick up the medication until documentation has been received.  New orders are required for each school year.
The provider must specify that a medication can be self-carried on the order and the parent/guardian and district nurse must agree that the student is mature enough to administer the medication.  Self-carry abilities can be taken away by the district nurse if medication not used appropriately.

The following orders may be used, depending on the need:
     -Medication Administration Form
     -Asthma State Plan
     -Allergy State Plan
     -Seizure State Plan
Dunstan’s district nurse has to sign off on each provider’s order and check all medications given in the health room.

For all question regarding medication or health needs, please contact Lydia Potter, RN at 720-695-9335 or

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