DC Health requires a plan before school health suite personnel give a student medication or perform a medical procedure at school, renewed annually under D.C. Code 38-651.03. This one-page form combines the parent's authorization with the licensed provider's medication plan (Part 2a) or procedure treatment plan (Part 2b). It goes to the school's Health Suite Personnel.
The parent completes and signs Part 1. A licensed health care provider completes Part 2a for a medication or Part 2b for a procedure, then signs and adds the office stamp.
Download the current version from the source each time; forms change without notice.
Medication and Medical Procedure Treatment Plan
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Every school year, and whenever the student's health or treatment requirements change. The parent acknowledges this in Part 1, and the provider marks the plan as new, a renewal or a change in Part 2a or 2b.
Yes. DC Health posts the Medication and Treatment Authorization Form in English, Spanish, Amharic, Chinese, French, Korean and Vietnamese on its School Health Services Program page. The current English edition is dated July 2024.