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Authorization to Administer Prescribed Medication

Release and Indemnification Agreement

About this Form

Form number: 525-13

Audience:  Attending Physician, Parents/Guardians

Last revised: February 2017

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Form 525-12 - Authorization to Provide Medically Prescribed Treatment

Form 525-14 - Emergency Care for the Management of a Student With a Diagnosis of Anaphylaxis

INFORMATION: The Montgomery County Department of Health and Human Services and Montgomery County Public Schools discourage the administration of medication to students in school during the school day. Any necessary medication that possibly can be administered before and after school should be so prescribed. Only non-parenteral medications are administered except in specific emergency situations. School personnel will, when it is absolutely necessary, administer medication to students during the school day and while participating in outdoor education programs and overnight field trips, according to the procedures outlined on the back of this form.

Adobe PDF Authorization to Administer Prescribed Medication
Release and Indemnification Agreement
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