• If your child needs to take/have medication at school for a health condition, either daily or on an “as needed” basis, (such as an Epi-Pen or inhaler), you must complete and submit one of the two forms described below:


    • “Request for Medication” form - DPS Form 1 (school staff administer the  


                Form 1 in English 

                Form 1 in Spanish 


    • “Authorization for Self-Medication” form - DPS Form 2  (your child carries and administers the medication as needed (ie: inhaler, Epi Pen,Tylenol, etc.).                 

              Form 2 in English                                                                                                      

              Form 2 in Spanish 


    Carefully read and sign the medication forms, have your health care provider complete and sign the appropriate sections of the forms, then submit the completed form to the school.   If the forms aren’t fully completed, they will be returned to you by the school for correction. 


    Your child should not have medication at school unless one of these forms has been submitted to the school for the current school year.


    If you have any questions about your child’s healthcare needs, please contact the school or the school health nurse, Daryl Mallet, RN at daryl.mallet@dpsnc.net.