Microsoft word - medical-consent-form.doc

MEDICAL MATTERS Senior School
It is most important that this form is completed and returned to the School NAME OF PUPIL: ……………………………………………………………

FOR ALL PUPILS.
1. Please complete the accompanying sheet providing background medical information about your 2. There are times when in the interests of the health and safety of your child that necessary medical information is conveyed to relevant staff including PE staff and to those organising school trips. We are required to seek your approval for this. 3. If a pupil has had any illness and/or medication during school holidays it is important that the
Medical Centre is informed of this before or at the start of term.
DAY PUPILS
Please read the relevant sections of the ‘Notes for Parents of Day Pupils’ and in the ‘Parental Contract’
regarding Medical Matters.

In compliance with the Health and Safety policy issued by the Essex County Health and Safety Advisor we
are required to obtain written permission to give ‘homely remedies, as appropriate’, to day pupils. These
remedies include ‘Paracetamol’ for pain, cough linctus and throat lozenges. Also medication required for
emergency use e.g. ‘Hypostop’ for named diabetics, ‘Ventolin’ for named asthmatics, and antihistamines for
allergies.
Our policy states that no medication apart from the above may be given to day pupils, and then only
with written parental consent. All administration will be recorded in the pupil’s case notes. All other day
pupil medication is the parents’ and child’s responsibility. The school must be informed in writing if a
day pupil is on any medication, and if required to be brought to school such medication must be clearly
marked with the pupil’s name and kept in the Medical Centre (except such medication as Ventolin, for
example, which must be named and carried at all times). However, if a parent/guardian considers that a day
pupil is capable of self medication then the pupil may keep the medication in his/her locked locker after
informing the Medical Centre.
I have read the information referred to above and give my permission:
ƒ for my son/daughter to be given ‘Paracetamol’, cough linctus, throat lozenges, and medication required for emergency use ( e.g. ‘Ventolin’ for asthma) as discussed above, if deemed necessary by the school. ƒ and for necessary medical information about my son/daughter to be shared with relevant members In the event of a medical emergency I understand that every effort will be made to contact me, however if I cannot be reached, I hereby authorise the staff of Friends’ School to secure the necessary medical treatment for my child. Signature of parent/guardian .Date.
Failure to complete and return this consent form could jeopardise the health and safety of your
son/daughter. Please also complete and return the accompanying ‘Medical Information Sheet’
See overleaf for Boarders


BOARDERS

Please read the relevant sections of the ‘Notes for Parents of Boarders’ and in the ‘Parental Contract’
regarding Medical Matters.

Medical treatment for boarders is normally entrusted to the Doctor chosen by the school under the
National Health Service. Parents must sign below to give the school doctor and nurses the
authority to carry out the necessary treatment and to administer medication when necessary.
Please note that it is not possible for the school to organise an NHS dentist.
I have read the information referred to above and give my permission:
ƒ for my son/daughter to receive medical treatment and medication provided by the school doctor, nurses and house staff, subject to any stipulations as indicated below. ƒ for necessary medical information about my son/daughter to be shared with relevant members of ƒ In the event of a medical emergency I understand that every effort will be made to contact me, however if I cannot be reached, I hereby authorise the staff of Friends’ School to secure the necessary medical treatment for my child.
Failure to complete and return this consent form could jeopardise the health and safety of your
son/daughter.
Please also complete and return the accompanying ‘Medical Information Sheet for Pupils’
Signature of parent/guardian .Date.
Please list below details of any stipulations regarding the non-emergency administration of medication
such as homeopathic remedies.
September 2011

Source: http://www.friends.org.uk/wp-content/uploads/Medical-Consent-Form.pdf