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1194 Holland Road
♦
Simpsonville, S.C.
29681
♦
864-355-3700
♦ FAX: 864-355-3783
Friday, June 2, 2023
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Please print forms and return to the health room before sending medications to school with students.
AUTHORIZATION FOR NON-PRESCRIPTION MEDICATION
AUTHORIZATION FOR PRESCRIPTION MEDICATION
AUTHORIZATION FOR MEDICAL PROCEDURES AT SCHOOL
For Epi Pen
ANAPHYLAXIS MEDICATION AUTHORIZATION
For Inhalers: Both Forms Must be Completed and Returned
STUDENT INHALER AGREEMENT
Safe Access to Vital Epinephrine (SAVE) Act