Medication forms for Students with Asthma

  • Please read the following important points prior to downloading the attached forms.

    • The attached Asthma Action Plan meets NJ Law N.J.S.A. 18A:40-12.8
    • Every child who will be using an inhaler or nebulizer in a New Jersey school is required to have a completed Asthma Action Plan on file in the nurse's office.
    • Be sure that the Asthma Action Plan is complete prior to bringing the form to the nurse’s office. (Areas often missed are triggers, parent signature, provider stamp and the box where you check if a student can self-administer.)
    • Students at the middle school level are permitted to self administer and carry their prescribed inhalers provided there is a physician's order on file and both the parent and the child's physician agree that the child is able to self administer his/her inhaler.  Be sure your child's name is written on the inhaler.


    ** NOTE** The new Asthma Action Plan has a parental authorization section included on the form. The additional district self carry form is no longer required.

    Medication will not be accepted in the nurse’s office without the proper completion of the Asthma Action Plan. 

    Forms can be picked up in the nurse's office or downloaded by clicking the link below.