• Medication Form (PDFversion)

    ALL forms need to be signed by the Physician and the Parent/Guardian 

    Please click on Blue links for printable medication forms.

    (All prescription or Over-The-Counter (OTC) medications)


    All Medications- Medication Form-One form must be completed for every medication kept in the clinic.

    Asthma/Inhalers- Medication Form & Asthma Action Plan

    Allergy/EpiPen- Medication Form & Allergy/Anaphylaxis Action Plan

    Seizure Meds (Diastat) - Medication FormSeizure Action Plan Students need a Seizure Action Plan even if they are not going to have medications at school

    Diabetic- Medication Form for each medication needed and Diabetes Action Plan


    Medication Policy

    No student will be allowed to bring medicine to school.  The preference of the Biloxi Schools is never to administer a prescription medication to a student; but we understand that at times there are needs that justify dispensing prescription drugs. Medication prescribed by a licensed doctor/nurse practitioner can be administered to students at school if necessary. When a doctor prescribes a medication, the parent must arrange with a doctor for the child to receive the medication at times other than during school hours. If the doctor feels it is necessary for the medication to be given at school, the parent must adhere to the following procedure:


    1. No student will be allowed to bring any medicine to school and take it without school office personnel supervision; all medication must be brought to the school by the parent/guardian, with the exception of number 5 below.

    2. In the event a medication is brought to the school by a student, the medicine will be immediately confiscated, and the student may be referred to the building administrator for disciplinary action, with the exception of number 5 below.

    3. The parent must bring the medication to the school in the original prescription bottle, which must be labeled as prescribed by law.

    4. The written consent form must be signed by the parent and the physician and returned to the school before any medication will be dispensed to the child.

    5. A student may carry an inhaler for asthma if a licensed medical physician or licensed nurse practitioner provides written documentation on the proper school form. The parent and the physician must complete an asthma action plan and return it to the school nurse.

    6. It is the parent's responsibility to transport medication to the in-school suspension location should his/her child be assigned to in-school suspension as a result of a disciplinary infraction.

    7. A student may carry auto-injectable epinephrine if ordered by their physician or nurse practitioner. Written permission signed by the physician/provider and parent must be documented on the district form, Anaphylaxis Action Plan.



    1. All medication dispensed must be done by approved school office personnel, with the exception of the asthma inhaler.

    2. It is the responsibility of the student taking medication to keep up with his/her medication time.