The horizon christian academy
HORIZON CHRISTIAN ACADEMY
CONSENT TO ADMINISTER MEDICATION AT SCHOOL
In order for school personnel to administer prescribed or over-the-counter medications such as Tylenol to a student, the following information must be on file and contain the written consent of the parent or guardian. No medication will be given by school personnel without the written consent of a parent or guardian. Student Name __________________________________________________________________________
Date of Birth______________________Grade__________
Daytime Phone__________________________________Emergency Phone________________________________
_____I wish to be contacted BEFORE ANY MEDICATION IS ADMINISTERED TO MY CHILD
Please select and complete info for medications approved to administer to your child.
Topical Creams (poison ivy, anti-itch, etc.)
(please include name of medication, dose, etc.)
Under NO CIRCUMSTANCES should my child receive the following medications_________________________
Special Instructions and/or conditions we should be aware of. Ex inhaler, heart disease, Epipen, etc.
Special instructions/storage for Medication____________________________________________________________
Possible side effects and action to be taken if they occur___________________________________________________
Physician / Health Care Provider________________________________________Phone________________________
Prescription medication - must be in a clearly marked container from a pharmacist. The label must show the student’s name, the dosage directions, the physician / health care provider’s name and the prescription number.
Over-the-counter medication - must be in the original container labeled with the student’s name and dosage directions.
No student is permitted to carry or self-administer his or her own medication at school. Medication(s), including prescription and over-the-counter, must be delivered to the office at the start of the school day.
Students must arrive at the front desk in a timely fashion to receive their medication.
The parent/guardian has the sole responsibility for ensuring that prescriptions are filled or re-filled as needed.
This form is valid for the current school year (2013/2014) beginning with the first day of school in August.
The undersigned agree not to file or make any claim against anyone for negligence in connection with the administration or non-administration of any medicines and further agree to save such individuals and hold them harmless from any liability incurred as a result of the administration or non-administration of any medicines. I give my permission for the Chief Administrator of Horizon Christian Academy, or his/her designee to administer the prescribed medication. Signature of Parent / Guardian ___________________________________________Date______________
A frontal assessment battery at bedside B. Dubois, MD; A. Slachevsky, MD; I. Litvan, MD; and B. Pillon, PhD Article abstract— Objective: To devise a short bedside cognitive and behavioral battery to assess frontal lobe functions. Methods: The designed battery consists of six subtests exploring the following: conceptualization, mental flexibility, motor programming, sensitivity to interfe
9. Auflage (2012), erstellt und überarbeitet v. PD Dr. T. Bartsch Klinik für Neurologie des Universtätsklinikums SH, Kiel (Dir.: Prof. Dr. G. Deuschl), Neurozentrum, Schittenhelmstr 10, 24105 Kiel Inhaltsverzeichnis . 2 Hirnnerven-Störungen . 2 Motorik . 5 Sensibilitätsstörungen und Schmerzformen . 7 Schmerzsyndrome . 9 Cerebelläre Funktionsstörungen . 11 Schwindel . 13 Dysarthrie .