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Texas School Health Program

Texas School Health Program

Required Reporting Forms

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Texas School Health Program
PO Box 149347
MC 1945
Austin, TX 78714-9347
United States

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1100 West 49th Street
Austin, TX 78756
United States

Asthma – Required Reporting of Unassigned Administered Medications for Respiratory Distress to DSHS

School districts, open-enrollment charter schools and private schools must report the administration of unassigned medications for respiratory distress. This requirement is in the Texas Education Code, Section 38.2091.

No later than the 10th business day after the date a school personnel member or school volunteer administers medication for respiratory distress, the school must submit a report in accordance with the 25 Texas Administrative Code, Part 1, Chapter 40, Subchapter D, Section 40.47 to all of the following:

  • School District
  • Charter holder if the school is an open-enrollment charter school
  • Governing body of the school if the school is a private school
  • Prescribing physician
  • Student’s primary healthcare provider
  • Commissioner of the Department of State Health Services (DSHS)

You must save a copy of the report in the student’s permanent record.  

Submission of this electronic form meets the reporting requirement for DSHS. Be sure to report complete and accurate information.

School Information
Spell out the school district, open-enrollment charter school, or private school’s name.
Do not use an abbreviation.

Recipient Information
Person who received the medication for respiratory distress:
Did the person who received the medication for respiratory distress have a history of asthma?
If it was a student who received the medication for respiratory distress, do they have an asthma action plan?
(Select N/A if this report is for school personnel, school volunteer, or visitor.)

Location and Dosage Information
(Examples: nurse’s office, classroom, hallway, etc. A mailing address is not needed.)
(Example: 1 dose of Metered Dose Inhaler = 2 puffs; 1 dose of Nebulizer = 1 unit-dose vial)

Other Information
(Examples: 6th grade teacher, school librarian, basketball coach, school volunteer, etc.)
Which of the following were notified after the medication was administered? Please select all that apply.
(Examples: 9-1-1 was called, emailed prescribing physician that medication was used, etc.)
After the medication was administered, the recipient:

Symptom Information
 

Please select the symptoms the individual who received the medication was exhibiting. Mark all that apply.

If no respiratory symptoms occurred, choose “N/A” and write symptoms in the “other” category. *

Symptom Information
If you selected "other" above, please explain.

Suspected Asthma Triggers

Please indicate the suspected cause or trigger of the individual's respiratory distress (Check all that apply*):
If you selected “Other”, please explain *

Remember to replace the medication for respiratory distress and the equipment used to administer the medication.

If you used a metered dose inhaler, make sure you wipe it down with a sterilizing solution.
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