• Required Reporting of Administered Unassigned Asthma Medication to DSHS

    If you are a school district, open-enrollment charter school, or private school there are reporting rules. The rules apply to unassigned asthma medication. The rule says you must report the administration of unassigned asthma medication. This requirement is in the Texas Administrative Code, Subchapter D, Title 25, Part 1, Chapter 40, Section 40.47.

    Your campus must submit a report no later than the 10th business day after the date a school nurse administers unassigned asthma medication. You must send the report to the:

    • school administrator,
    • prescribing physician,
    • student’s primary healthcare provider, and
    • 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.

    Please fill out the entire form and provide detailed information.
    All fields with an asterisk (*) must be completed.

    Certain Entity/Venue Information

     

    Remember to report this information to the school administrator, the prescribing physician and the student’s primary healthcare provider and keep a copy in the student’s permanent record.

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

    Location and Dosage Information

     

    (Examples: nurse’s office, classroom, hallway, etc. A mailing address is not needed.)

     


    (Example: 2 puffs = 1 dose)
     [None] Select a Date Delete the Date

    (Must be a school nurse, as defined by statute: School nurse--Registered nurse, as defined in 19 TAC §153.1022, authorized to administer asthma medication, or licensed vocational nurse working under supervision as described in Texas Occupations Code §301.353.)

    Other Information

     

     

     

     

     

     

    Symptom Information

     

    Please select the symptoms the individual who got the unassigned asthma medication was exhibiting. Mark all that apply.

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

    Suspected Asthma Triggers

     

    Please indicate the suspected cause or trigger of the asthma attack
    (Check all that apply*):

    Remember to replace the unassigned asthma medication 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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Last updated February 11, 2021