If student will need to carry this medication (Asthma Inhalers, Epi-Pens, Diastat, or Intranasal Versed), the doctor will also need to complete and sign a Written Authorization for Self Administration of Medication by Minor Child at School.

This form is mandatory for students to be able to carry their Asthma Inhalers, Diastat, Intranasal Versed, or Epi-Pen. 

A physician must complete and sign this form.