Permission for Over the Counter Medication

New York State Education Law requires prior written approval from both a healthcare provider and the parent/legal guardian for over-the-counter medication (OTC) to be administered in school.
These OTC medications and treatments include:

• Aquaphor or Vaseline topically as needed for chapped skin or lips
• Lotion (unscented) topically as needed for dry skin or minor skin irritation
• Calamine lotion, Caladryl or hydrocortisone cream topically as needed for an itchy rash or insect bite
• Antibiotic ointment (Bacitracin or Polysporin) topically for a minor skin cut, abrasion, or wound
• Salt water to be gargled for sore throats or applied to canker sores as needed
• Acetaminophen (Tylenol) suspension 160mg/5mL or 325mg tablets for headache or pain, dispensed per weight per package instructions
• Ibuprofen (Advil) suspension 100mg/5mL or 200mg tablets, for menstrual, muscular-skeletal, or headache pain dispensed per weight per package instructions
• Diphenhydramine (Benadryl) suspension 12.5mg/5mL or 25mg tablets for seasonal allergies or allergic reactions dispensed per weight per package instructions

If you and your healthcare provider opt for access to these items at school, please have your medical provider complete the form below.