Parent_authorization_ acetamin-ibuprofen-tbski

PARENT AUTHORIZATION FOR ADMINISTERING
ACETAMINOPHEN (tylenol) or IBUPROFEN (advil)
Student ______________________________ Birthdate _____________ Grade______ I, ______________________________, give my consent for ________________________________ (Print) Parent/Legal Guardian Name (Print) Student’s Name to be administered Acetaminophen/Ibuprofen (circle one or both) during the period he/she is
enrolled in this school. If consent is granted, I agree to release the District from liability for the
dispensation of the medication.
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TUBERCULIN/PPD SKIN TEST CONSENT OR EXEMPTION
Signature below gives consent for my child to receive the Mantoux PPD tuberculin skin test required for kindergarten, 7th grade and new-to-district students*. This is an intradermal injection of tuberculin antigen, PPD (purified protein derivative). You may choose to provide a PPD test result given elsewhere. CHOOSE AND INITIAL ONE STATEMENT ONLY! ____ I consent to the PPD skin test for my child at school and I do not need to be present. Initial ____ I will provide the PPD test result, read by another health provider, for the school nurse Initial within 90 days after the start of kindergarten or 7th grade; or new-to-district enrollment. (The PPD skin test given six months prior to school entry is acceptable.) ____ I consent to the PPD skin test for my child at school and want to be at school when the Initial skin test is given. ____ My child is exempt from TB testing because of a previous positive PPD test with an Initial Initial reading of 10mm or more. Parents must provide health history information about the chest x-ray from a health care provider and medication taken because
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* - Alaska State law requires PPD (purified protein derivative) tuberculin skin testing within 90 days of enrollment for all students in kindergarten and 7th grade; or each child who enrolls in the Juneau School District in grades kindergarten or higher for the first time (27 AAC 27.213). Students previously enrolled in the City and Borough of Juneau School District, who are returning from another district, are not considered new to the district. Exemption from PPD testing is permitted if you provide results from a PPD skin test given within six months prior to school entry, or if a physician states that skin testing would be injurious to your child’s health. If your child had a previous positive PPD test with a reading of 10 mm or more, a skin test is not required. A BCG vaccination is not an exemption from tuberculin testing, and there is no exemption from tuberculin skin testing for religious belief or personal objection. If you have any questions please contact the school nurse.

Source: https://tmhs.juneauschools.org/uploads/tmhs/pdfs/registration/Parent_Authorization_%20Acetamin-Ibuprofen-TBSki.pdf