(b) Any pupil, who is required to take during the school day a medication prescribed by a licensed physician, advanced registered nurse practitioner, licensed physician's assistant or dentist, shall have a school nurse either assist the student to take the medication or administer the medication.

(c) This duty may also be undertaken by a RN or LPN under the direction of the school nurse.

(d) The school nurse may delegate the administration of medications, if appropriate to others pursuant to RSA 326-BNurse Practice Act and Nur 404.

(e) Asthma inhalers and epinephrine auto injectors may be possessed by a student and self-administered in accordance with RSA 200:42 through RSA 200:47.

(f) If the school nurse is not available the building principal or designee may assist students in taking required medications by:

• (1) Making such medications available to the student as needed;

• (2) Observing the student as he/she takes or does not take his/her medication; and

• (3) Recording whether the student did or did not take his/her medication.

I. (a) The state board of education, after consultation with the department of health and human services, shall adopt rules pursuant to RSA 541-A for addressing incidents of hypoglycemia resulting in unconsciousness, seizure, and/or the inability to swallow in order to provide for the health and safety of children who have been medically identified as having diabetes. The rules shall provide that:

• (1) A parent or legal guardian of any child may authorize a school employee, or person employed on behalf of the school in cases where there is no school nurse immediately available, to administer glucagon to a child in case of an emergency, while at school or a school sponsored activity;

• (2) The glucagon shall be kept in a conspicuous place, readily available; and

• (3) Glucagon administration training may be provided by a licensed physician, physician assistant, advanced practiced registered nurse, or registered nurse, however in no case shall school nurses be required to provide training;and the school administration shall allow school employees to voluntarily assist with the emergency administration of glucagon when authorized by a parent or legal guardian.

• (b) No school employee shall be subject to penalty or disciplinary action for refusing to be trained in glucagon administration.

• (c) A parent or legal guardian shall provide a diabetes management plan or physician's order, signed by the student'shealth care provider, that prescribes the care and assistance needed by the student including glucagon administration.

II. The state board of education, in conjunction with the American Diabetes Association, and the New Hampshire chapter of American Academy of Pediatrics, shall develop Standard and guidelines for the training and supervision of personnel, other than the school nurse, who provide emergency medical assistance to students under this section. Such personnel shall only be authorized to provide such assistance upon successful completion of glucagon administration training.

A pupil with severe, potentially life-threatening allergies may possess and self-administer an epinephrine auto-injector if the following conditions are satisfied:

I. The pupil has the written approval of the pupil's physician and, if the pupil is a minor, the written approval of the parent or guardian. The school shall obtain the following information from the pupil's physician:

• (a) The pupil's name.

• (b) The name and signature of the licensed prescriber and business and emergency numbers.

• (c) The name, route, and dosage of medication.

• (d) The frequency and time of medication administration or assistance.

• (e) The date of the order.

• (f) A diagnosis and any other medical conditions requiring medications, if not a violation of confidentiality or if not contrary to the request of the parent or guardian to keep confidential.

• (g) Specific recommendations for administration.

• (h) Any special side effects, contraindications, and adverse reactions to be observed.

• (i) The name of each required medication.

• (j) Any severe adverse reactions that may occur to another pupil, for whom the epinephrine auto-injector is not prescribed, should such a pupil receive a dose of the medication.

Immediately after using the epinephrine auto-injector during the school day, the pupil shall report to the nurse's office or principal's office to enable the nurse or another school employee to provide appropriate follow-up care.

The school nurse or, if a school nurse is not assigned to the school building, the school principal shall maintain for a pupil's use at least one epinephrine auto-injector, provided by the pupil, in the nurse's office or in a similarly accessible location.

A pupil may possess and use a metered dose inhaler or a dry powder inhaler to alleviate asthmatic symptoms, or before exercise to prevent the onset of asthmatic symptoms, if the following conditions are satisfied:

I. The pupil has the written approval of the pupil's physician and, if the pupil is a minor, the written approval of the parent or guardian. The school shall obtain the following information from the pupil's physician:

• (a) The pupil's name.

• (b) The name and signature of the licensed prescriber and business and emergency numbers.

• (c) The name, route, and dosage of medication.

• (d) The frequency and time of medication administration or assistance.

• (e) The date of the order.

• (f) A diagnosis and any other medical conditions requiring medications, if not a violation of confidentiality or if notcontrary to the request of the parent or guardian to keep confidential.

• (g) Specific recommendations for administration.

• (h) Any special side effects, contraindications, and adverse reactions to be observed.

• (i) At least one emergency telephone number for contacting the parent or guardian.

• (j) The name of each required medication.

II. The school principal or, if a school nurse is assigned to the pupil's school building, the school nurse shall receive copies of the written approvals required by paragraph I.

III. The pupil's parent or guardian shall submit written verification from the physician confirming that the pupil has the knowledge and skills to safely possess and use an asthma inhaler in a school setting.

IV. If the conditions provided in this section are satisfied, the pupil may possess and use the inhaler at school or at any school sponsored activity, event, or program.

V. In this section, “physician” includes any physician or health practitioner with the authority to write prescriptions.

I. A school nurse and designated unlicensed assistive personnel may administer or make available to self-administer a bronchodilator, spacer, or nebulizer to a student who has been diagnosed with asthma for use in emergency or other situations as determined by the school nurse provided that:

• (a) The school has on file an asthma action plan for the student which shall be filed annually and updated as necessary with the school and includes an order from the student’s health care provider to provide the student with an asthma rescue inhaler, including dosage information and permission for the student to use the school’s stock in the event of an emergency; and

• (b) The student’s parent/guardian has provided written permission to the school nurse to administer a bronchodilator, spacer, or nebulizer from the school’s supply.

II. The school nurse shall notify the student’s parent or legal guardian whenever a bronchodilator, spacer, or nebulizer from the emergency stockpile is administered to a student. The school nurse shall make the notification as soon as practicable in accordance with the contact information on file at the school.