Jeffco Public Schools

Medication Forms

Parents must provide a Medication Agreement, filled out and signed by their healthcare provider if their student has a condition that will require the administration of any medication during the school day, including over-the-counter and prescription medications.

Parents will provide medication in original packaged or prescription container that has not expired along with the appropriately signed medication form (below). Once received, a nurse may delegate administration of either a prescription or over-the-counter medication, based on the health care provider's order.

According to BOE policy JLC and Colorado Nursing Board Policy #30-04, district nurses have the obligation to call physicians directly to verify orders if needed.

• Medication Agreement (New 8/17: Different languages with standardized second page in English for MD to read, fill out, and sign.)  
  English | Russian | Spanish
• Extended Field Trip Medication Protocol
  • Extended Field Trip Medication Form Elementary
  • Extended Field Trip Medication Form MS HS use this form for any trip overnight away from school. 
    
  • Parent Checklist for Extended Field Trips
    

Mask Exemption RequEsts

Requests for mask exemptions for medical/disability reasons can be submitted by families through this Mask Exemption Google Form  | Español.  Please log into a Google account to complete the form (families can login to their student's Jeffco Google account using the student ID login if the parent/guardian does not have a Google account).

Medical exemptions will be requested through the Mask Exemption Google Form  | Español and require a statement provided on an appropriate healthcare professional's letterhead/form and include the following:

• Printed name, license number, address, phone number, and signature of a medical provider.  
• Identification of the medical, mental health, or other condition/disability that prevents the student from wearing a mask, and any alternative to a mask if necessary.
• Parent/guardian will be asked to upload (pdf,doc, image) this statement when completing the Mask Exemption Google Form | Español.

Asthma Care Plan

Students diagnosed with asthma and require an inhaler or medication at school will need to have their health care provider and parents complete the Colorado Asthma Care Plan (please download and print rather than print from browser window) and return it to the school clinic aide along with the medication. Parents of student with asthma or health concerns are also encouraged to contact their District RN to follow up regarding care and support at school.

Students with Food Allergies

The Jefferson County Board of Education recognizes that many students are being diagnosed with potentially life-threatening food allergies. To address this issue and meet state law requirements concerning the management of food allergies and anaphylaxis among students, the board has established Policy JLCDA, which specifies details regarding a health care plan, reasonable accommodations, access to emergency medications and staff training. Parents, the school administrator, and the District RN will develop a health plan using the Colorado Allergy and Anaphylaxis Care Plan (please download and print rather than print from browser window), have your care provider fill out and return to the school.