EBBA-3R

ROCHESTER PEDIATRIC ASSOCIATION

165 CHARLES STREET

ROCHESTER, NH 03867

STANDING ORDER:

Tylenol 1 or 2 prn for students grade 7-12.

PURPOSE: To keep students in school who otherwise would apt to be dismissed for the day.

CRITERIA FOR ADMINISTERING:

1. Nurse's evaluation and discretion.

2. Parental consent (written or telephone)

3. For minor physical complaints (headache, dysmenorrhea, sprains)

4. A small fee may be charged to defray costs.

Physician's Signature

Date: