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Over-the-Counter Medication Consent

Over-the-Counter Medication Consent Information
Per Policy 453.3, Medication Administration to Students and Procedure 453.3, Item 6

  • The Menomonee Falls School District will supply generic ibuprofen, acetaminophen, and Tums for students in the middle and high schools. Elementary schools will not provide stocked medication.
  • Menomonee Falls School District personnel will only administer the recommended therapeutic doses of these medications per packaging instructions. For the safety of the student, a written request from the parent/guardian and the licensed medical provider is required if the dose is anything other than the recommended therapeutic dose found on the packaged label.
  • Stock medications will not be given in combination with other non-prescription medications that may already contain acetaminophen or ibuprofen.
  • Only one dose of these medications will be administered during the school day.
  • Stocked medications will not be administered for more than three days in a row or eight days per month without documentation from a medical provider.
  • This request is for the current school year only.

I give permission to give:

  • Tylenol (acetaminophen) OR Motrin (ibuprofen)
  • Tums (calcium carbonate)
  • Acetaminophen or ibuprofen is given as needed for complaints of headache, pain, menstrual cramps, or dental discomfort.
  • Tums given as needed for upset stomach or indigestion.

WARNING: Parents/guardians, please refer to the manufacturer's medication label for medication warnings or side effects

Click here to download the Over-the-Counter Medication Consent Information.