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Pflugerville High School

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Medication Forms

Medication Administration Form - English

If your child needs medication while at school, the school must have a "Request to Dispense Medication" form on file. The form must be signed by a parent or guardian. Prescription medication must be in the prescription container. Non-prescription medication must be in the original container. This form must be updated yearly and be kept on file at the Nurse's Office.

Asthma Self-Administration Form

If your child need to self administer his / her own inhaler, the school must have a self-administration form on file. This form is signed by the parent and physician. It must be updated yearly and kept on file at the Nurse's Office.

Epinephrine (Epi-Pen) Self Administration

If your child needs to self administer or possess Emergency Anaphylaxis Medication (Epi-pen), the school must have a self-administration form on file. This form is signed by the parent and physician. It must be updated yearly and kept on file at the Nurse's office.

Medication Administration Form - Spanish

Si su hijo necesita medicamento en la escuela, la escuela debe tener una "Solicitud para Dispensar Medicamentos" en el archivo. El formulario debe ser firmado por el padre o tutor. Los medicamentos recetados deben estar en su envase. Otros medicamentos deben estar en su envase original. Este formulario deberá ser actualizado anualmente y se mantendrá en archivo en la oficina de la enfermera.