Epinephrine

Pursuant to Title 18A:40-12.3 through 12.6, Lenape Regional High School District shall permit students who have a potentially life-threatening allergic reaction to carry and self-administer prescribed medication without supervision of the school nurse. A life-threatening allergic reaction is a condition that requires an immediate response to specific symptoms that, if left untreated could lead to potential loss of life.

Additionally, the statute requires the delegation of epinephrine administration via an auto-injector by trained individuals, with parental approval, in the absence of the school nurse at a school-sponsored function. A delegate will be trained to recognize the signs and symptoms specifically related to the child’s condition, as well as how to administer epinephrine via a pre-filled auto-injector.

In order to facilitate meeting the requirements of the law, it will be necessary for parents/guardians and their family doctor to complete the Physician/Parent Authorization Form below and return it to the Nurse’s Office at the beginning of each school year. It is equally necessary for parents/guardians to provide the school with a least one epinephrine auto-injector for their student’s use at school. This is in addition to the auto-injector that the child may carry with them. The medication should be supplied to the Nurse’s Office and labeled with the original pharmacy label.

Please be advised that the Lenape Regional High School District and its employees or agents shall incur no liability as a result of any injury arising from the self-administration of medication by the child, and that parents/guardians must agree, by completing the Physician/Parent Authorization consent form, to indemnify and hold harmless the school district and its employees or agents against any claims arising out of the self-administration of medication by the child. In addition, neither the school nurse nor delegate shall incur any liability as a result of any injury arising from administration of medication to the student.

Permission for self-medication is effective for the school year for which it is granted and must be renewed for each subsequent school year upon fulfillment of the requirements listed above.