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G. C.

BURKHEAD
ELEMENTARY SCHOOL








PBIS Handbook

GCB utilizes the Positive Behavior Interventions Support (PBIS) approach to school-wide discipline



SCHOOL-WIDE EXPECTATIONS STAFF AND STUDENTS

PAWS
1. Personal Best Give you best effort each day, strive for success
2. Act Responsibly- Be responsible in your actions, be on time, be dependable
3. Work with Integrity- Honest, fair and quality work
4. Show Respect- Show respect with staff, students and guest

CLASSROOM EXPECTATIONS
1. Teachers and students will establish classroom expectations that coincide with school
expectations.
2. Clip Up and Clip Down Chart will be used to monitor student behaviors
3. Bruin bucks will be used for the positive reinforcement of behavior
4. Teachers will communicate poor behaviors with parents
5. Follow PAWS


CAFETERIA EXPECTATIONS
1. Use voice level 2 or lower
2. Keep hands and feet to yourself
3. Stay seated at all times with feet under the table (raise hand for help)
4. Food is not to be played with, shared, or traded
5. Clean your area before being dismissed

HALLWAY EXPECTATIONS
1. Use voice level 0 unless directed to speak at level 1
2. Walk on the right side of the hall while facing forwards.
(Always enter using the right side door)
3. Hands, feet and belongings to self Respect others and school facilities
4. Lines are single file and close together (no gaps)
5. Follow PAWS

RESTROOM EXPECTATIONS
1. Use voice level 1 while in restroom
2. 6 student maximum in restroom at any one time
3. Show respect for privacy and facilities
4. Use restroom, wash hands, and immediately exit restroom
5. Follow Paws

PLAYGROUND EXPECTATIONS
1. Voice level 3 or lower
2. Stay in designated areas as directed by teacher
3. Use safe actions, report any potentially dangerous activities.
4. Keep hands and feet to yourself
5. Follow PAWS

SPECIAL AREA CLASS BEHAVIOR
Misbehavior in special area classes will result in the same consequences as in the regular
classroom. Special area teachers will communicate Clip Up or Clip Down with homeroom
teacher after each class period. The homeroom teacher would then hold them accountable on the
Clip-Chart in the classroom. The specialists are still responsible for making contact with the
parent if the behavior warrants such an action or for filling out the Office Referral form.

AFTER SCHOOL DETENTION
Detention will be held in the Library on Thursday of each school week, from 2:30-3:30. Students
can be assigned detention for the following violations that include, but are not limited to, lack of
work completion, misbehavior, or other behaviors. Parents/Guardians are responsible for picking
students up from detention at the library doors at 3:30. A certified staff member will check
identification of those persons picking up students; only authorized adults, on file in the office or
specified on the detention form, will be allowed to pick up students from detention.

PLAYGROUND GUIDELINES
One of the most important requirements in the safe use of playground equipment is the
restriction of activity to the general purpose for which a piece of equipment was designed. Many
playground accidents result from misuse of equipment, attempts to perform unsuitable stunts,
climbing on structures or swings, and general roughhousing.
To avoid such mishaps, adequate supervision of the students is necessary at all times while on
the playground.
Do not permit children to use damaged equipment.
Do not permit too many children on the same piece of equipment at the same time;
suggest that children take turns, or direct their attention toward other equipment or
activities.
Constantly observe play patterns to note possible hazards and suggest appropriate
equipment if usage changes.
Make periodic checkups and immediately request that worn or damaged pieces of
equipment be replaced.
Prepare written accident reports with special attention to surface conditions, type and
extent of injury, age and sex of child, how the accident occurred, and weather conditions.

In addition to the need for adequate supervision, students must be taught general safety practices
for the entire playground area, which should include:
1. No roughhousing.
2. No games such as tag should be played on or around equipment.
3. No throwing of debris on the playground.
4. No removal of sand or pebbles by students.
5. No equipment should be used when wet or ice-coated.
6. No equipment should be used without supervision.
7. Students should use only equipment designed for their age group.
8. Students must learn to take turns in using the equipment.



DRESS CODE:

Proper appearance not only makes for a good self-concept, but has also been shown to have a
high relationship to school pride and appropriate behavior. We ask that students and parents
accept their responsibilities concerning this matter. Parents will be contacted when a students
appearance is considered a possible distraction to self or others normal school progress and
orderly operation of the school.

Appropriate dress will consist of pants, jeans, athletic wear, Capri pants, skirts, shorts, skorts, or
jumpers, (mid-thigh length or longer). No low-rise or low-waist pants/jeans will be acceptable
to wear.
Words or logos are not to be offensive, negative, derogatory or a put-down of any nature.
All students must wear appropriately sized clothing. No sagging pants, shorts, etc.
All shirts must have sleeves. Shirts must also cover the waistband of pants so torso does not
show.
Each student is required to wear shoes at all times. Flip-flops, shoes w/heels and sandals are
unsafe and are not to be worn at school. The term sandals includes all open toes and backless
footwear. All shoes should support the foot appropriately while playing outside or exercising.
Tennis/Athletic shoes are most appropriate.
Head coverings are to be worn outside the school building. Hooded sweatshirts are permitted
but hoods should not be on inside the buildings.
Exceptions to the dress policy will be made for students with religious objections or students
with special needs only after a meeting with administration.

PBIS TIER 1 - BEHAVIOR MONITORING CLIP UP /CLIP DOWN CHART

Dear Parents,

This year we will be using a colored clip chart to monitor our behavior and classroom
choices. Your child will have a clip in the classroom that they will physically move up or down
the chart, depending on their choices. Please keep in mind that your child may not move every
single day! In order to move up, students must go above and beyond in their behavior choices.
The chart below explains how the clip chart works.

RED
Outstanding!
Students who reach the red
level will be rewarded for
their positive choices.
ORANGE
Great Day!
Students who continue to
make positive choices move
up to the orange level.
They are one step closer to
having outstanding
classroom behavior!
YELLOW
Good Job!
Students who make positive
choices will receive
recognition as they move up
the chart.
Green
Ready to Learn!
Everyone starts the day
Ready to Learn! Students
can clip up or clip down
throughout the day
depending on their behavior
choices.
BLUE
Slow Down -
Warning!
Students who receive a
warning will move to blue.
This serves as a reminder to
students to think about the
choices they make.
PURPLE
Think about It!
Students who continue to
make poor choices will
move to purple and will be
given a consequence.
PINK
Parent Contact
Parents will be contacted
that day if their child is on
pink.

I believe that this system will be a positive way for students to monitor their choices and
will give them behavior goals to strive for! If you have any questions, please dont hesitate to
contact me!
Sincerely,
\
PBIS BASED TIER 2 - BEHAVIOR MONITORING:



CHECK AND CONNECT

Check-In Check-Out (CICO) is a Tier II, group-oriented intervention, designed especially for
students whose problem behaviors (a) are unresponsive to Tier I practices and systems, (b) do
not require more immediate individualized interventions, and (c) are observed across multiple
settings or contexts. For example, the program can accommodate a number of students (e.g., up
to thirty), and students can enter the program within a few days following referral. CICO also
provides a built-in system for (a) monitoring students progress in the program, (b) evaluating
the fidelity of implementation, and (c) transitioning to a self-managed program.

Student receiving their 4
th
office referral or being referred by a teacher will be entered into this
CICO mentoring and behavior monitoring program.


Research conducted on CICO and similar programs have consistently demonstrated associated
decreases in problem behaviors, office discipline referrals, and referrals for special education
services.





The critical features that define CICO for students include the following practices:

Check and Connect- Practice Features


-wide behavioral goals and expectations
Frequent feedback
-school communication



Check and Connect Daily Activities

d on school-wide expectations











BEHAVIOR INTERVENTION TEAM

As part of behavior RTI students who get 4 or more referrals will be assigned behavior
interventions by the behavior intervention team to design a plan to help make them more
successful. The team will consist of a administrator, PBIS coach, special education instructor,
teachers and FRYSC member. A behavior plan with intensive interventions and wrap around
supports may be developed for the student if behavior does not improve. (Tier 3)





Tier 1 Tier 2 Tier 3

School wide Expectations

School wide incentives and
behavior supports

Minor behavior tracking

Major behavior tracking
Office Discipline Referrals

Proximity

Preferential Seating

Loss of Privilege

Detention/Consequences

Student and parent
conferences

Behavior Contracts

Check and Connect

Small Group Social Skills

Mentoring Program

FRYSC

Home Visits

Behavior Plans

Other

Counseling

Child Protection Services

Behavior Intervention Plan

Functional Behavior
Assessment

Legal

Risk Assessment

Support Agencies

Individualized Check and
Connect

Other
















GC BURKHEAD PBIS COMMITTEE


Josh Belcher Administrator

Jerrianne Hatfield Coach, Special Education

Crystal Wilkerson Intermediate

Regina Boone - Early Primary

Bill Wooldridge Middle Primary

Anita Riggs Special Areas

Suzanne Parrett FRYSC

Kim Miller - Classified


Meeting Dates:
Usually 3
rd
Wednesday of each month

Teaching Schedule:
Expectations and Procedures will be taught to students the first week of school and immediately
after long breaks, and as needed. Lesson Plan will be sent out for each area to be taught.

Reviewing PBIS with Staff:
The PBIS Committee will review PBIS and the discipline policy with the staff prior to the start
of school, and during faculty meetings throughout the year. The PBIS Self-Assessment Survey
will be administered yearly.

















LESSON PLANS FOR TEACHING EXPECTATIONS


Cafeteria Behavior Lesson Plan

Expected lesson length: 20 30 minutes with additional practice time.

Objective:
I will behave appropriately in the cafeteria.

Overall Goal of Lesson: The lunch area will be a safe and clean environment where all people interact
with courtesy and respect.

Tell Phase:
1. Student will use a level 2 voice or lower when in the cafeteria.
2. Students will enter lunch line through center of cafeteria.
3. Students will get all lunch items and supplies as they walk through lunch line, no returning.
4. Students will sit with their class and their assigned tables (K 5).
5. Students will use appropriate table manners and keep knees under the table and feet on the
floor.
6. All students are encouraged to eat lunch. (Staff will notify teachers and teachers will notify
parents if students dont eat, continuously).
7. Students will clean area before leaving tables.
8. Students will walk appropriate exit route.
9. Students will wait for the cafeteria monitor to dismiss them.
10. Students will line up in front of office. 3 5 students will enter/exit same doors using center
aisle.
11. Students will not share, trade, or play with food.
12. Students will be respectful to cafeteria staff and supervisors.
13. Each teacher selects 2 table cleaners for the week, each week to wipe down the tables.
14. Student will not be dismissed from table until ALL trash is on a tray to be thrown away

Show Phase:
Administrator will role play procedures, per grade level, the first day of school. Re-teach procedures
provided by classroom teacher after breaks

Do Phase:
Administrator will choose 1 class to demonstrate procedures.

Conclusion:
Ask and Answer questions from students.







Lesson Plan for Hallway


Objective:
Students and staff will conduct themselves in a safe, orderly, and respectful manner in the G.C.
Burkhead hallways.


Introduction phase:
Discuss the uses we have for the hallways: travel, waiting, working, discipline, small group
lessons, and Title 1.


Tell Phase:
Discuss the importance of having safe, orderly, and respectful behaviors in the hallways. Use a
chart to list acceptable behaviors for the hallway. Some examples are listed below. Encourage
student input and participation. (Teacher Led)


HALLWAY EXPECTATIONS
1. Use voice level 0 unless directed to speak at level 1
2. Walk on the right side of the hall while facing forwards.
(Always enter using the right side door)
3. Hands, feet and belongings to self Respect others and school facilities
4. Lines are single file and close together (no gaps)
5. Follow PAWS


Show phase:
Demonstrate desired behaviors. Teachers can do this or use small groups to role-play.



Do Phase:
Whole class goes in to the hallway and practiced these behaviors. Teachers should use feedback
and specific praise for students showing desirable behaviors. Teachers might also ask a student
to step out of line, be an observer, and offer praise to other students. The class might also
observe other classes in the hallway and offer them praise







Restroom Lesson Plan



Expected lesson length: 15 20 minutes.

Objective: Students will use appropriate procedures when going to restroom.


Goal of Lesson: To teach students how to make appropriate and respectful choices when using
restroom.


Tell phase:


RESTROOM EXPECTATIONS
6. Use voice level 1 while in restroom
7. 6 student maximum in restroom at any one time
8. Show respect for privacy and facilities
9. Use restroom, wash hands, and immediately exit restroom
10. Follow Paws


Show Phase:
Use a t-chart to list acceptable/unacceptable behaviors for the restroom. Some examples are
listed below. Encourage student input and participation.
Acceptable Unacceptable
Voice Level 1 Being too noisy
Respect others privacy Peeking under stalls, holding
restroom doors
Put toilet paper in toilet and flush Being messy
Clean hands Not washing hands or playing with
soap and water.

Do Phase:
Boys/Girls go into restroom and practice these behaviors. Teacher models appropriate restroom
behavior.

Conclusion: Ask the following questions:
What does promptly mean?
Why do we need restroom procedures?
Tell me 2 acceptable behaviors in the restroom?


GC Burkhead Elementary School
Major and Minor Office Infractions - Minimum Consequences for Behavior
Major Incidents
Office referral 1
st
offense
Minor Incidents
Office referral 4
th
offense
Cheating/Lying (Lying)
3 days LD

Leaving Campus (Out of Bounds)
1 day ISD

Harassment (Harrass)
day ISD

Bullying (Bullying)
day ISD

Property Damage (Prop dam)
3 days LD (restitution)

Physical Aggression (PAgg)
day ISD

Sexual Behavior Indecent Exposure (C-SBIE)
1 day ISD

Fighting (Fight)
1 day ISD

Technology Violation (Tech)
days ISD

Theft/Forgery/Plagiarism (Theft)
3 days LD

Tobacco (Tobacco)
1 days ISD

Drugs (Drugs)
5 days ISD

Skipping Class (Skip)
2 days LD

Weapons (Weapons)
3 days ISD /parent conference

Defiance (Defiance)
2 days LD

Profanity- Verbal and no-verbal (InappLang)
3 days LD

Arson (Arson)
3 day ISD

Minor Behaviors
Dress code violation (change of clothing)
Failure of restroom expectations
Horse play/running in halls or parking lot
Incomplete work/missing work/off task
Inappropriate language w/o profanity
Lack of materials
Low level defiance
Sleeping
Talking disruptively
Tardiness
Unprepared for class

2 Lunch Detention minimum
--------------------------------------------------------------------------------


Minor Low Level Aggression (arguing, physical contact)
Possible Bullying (gossiping, teasing)

3 Days Lunch Detention Minimum

Unapproved Cell Phone Use/IPOD/Ear Buds
Confiscation Parent Pick up of Phone

--------------------------------------------------------------------------------


Bus Behaviors (In addition to above)
Tied to school-wide consequences with possible bus suspension
*Bus referrals are submitted to the principal by bus driver


------------------------------------------------------------------------











*Students with multiple referrals will receive Tiered Interventions with specific behavior goals
KEY
OT- Office Timeout
LD - Lunch Detention
ISD - In School Detention
OSS - Out of School Suspension
Restitution- Paying for Damages








Sample Discipline Report:

Fill out all section other than Administrative Decisions and Comments.
*Only choose one behavior








OFFENSES FOR WHICH A STUDENT SHOULD BE SENT IMMEDIATELY TO A PRINCIPAL OR COUNSELOR:

Major Offenses:
Fighting (Fight,5001)
Physical Aggression (PAgg, 5001)
Disrespect (Disrespct, 127)
Defiance/Non-Compliance (Defiance, 1010)
Inappropriate Language-Profanity (M-Inapp Lan, 70)
Disruptive (M-Disruption, 2001)
Bullying (Bullying, 8001)
Harassment (Harass, 8002)
Property Damage (Prop dam, 005)
Forgery/Theft (Theft, 1009)
Lying/Cheating (Lying, 1001)
Skipping Class (Skip, 1004)
Technology Violation (Tech)
Inappropriate Display of Affection (Inapp affection, 60)
Sexual Behavior/Indecent Exposure (SBIE, 60/171)
Tobacco (Tobacco, 9003)
Drugs (Drugs, 1801)
Weapons (Weapons, 154)


Minor Offenses:

Dress Code Violation
Failure to follow Restroom Guidelines
Horse Play, Running in Halls
Inappropriate language (minor, non profanity)
Lack of Materials or Incomplete Task
Sleeping, Talking, Out of Seat (Disruptive)
Tardiness
Other

*Minor offenses that become consistent over time will also warrant an office referral on 4th
offense within a one month period. A parent notice by the teacher should occur no later than the
3rd offense.

CONSEQUENCES (but not limited to)

OT- Office Timeout
LD- Lunch Detention
ST- Social Timeout (Recess)
ASD- After School Detention
ISD- In School Detention (Whole day or partial day)
OSS- Out of School Detention

*3, 5, 10 day or yearly bus suspensions may occur for bus behaviors. Parents would be
responsible for the transportation of the student to and from school.

*Severity of the behavior, number of past infractions, and student cooperation will be
determining factors for the consequences that will be given.




DETENTION
Detention will be held in the Library on Thursday of each school week, from 2:30-3:30.
Students can be assigned Detention for the following violations that include, but are not limited
to, Lack of Work Completion, Misbehavior, or Other Behaviors.

Parents/Guardians are responsible for picking students up from Detention at the Library doors at
3:30. A certified staff member will check identification of those persons picking up students;
only authorized adults, on file in the office or specified on the Detention form, will be allowed to
pick up students from Detention.




















SCHOOL BUS SAFETY EXPECTATIONS AND PROCEDURES

A. For the safety of all students, each teacher should spend a specific amount of time on
these rules and practices during the first part of the school year. They should also be
reviewed periodically during the school year.

B. Students should be taught to following safety rules and practices:
1. Be at your bus stop 5 minutes before your scheduled pick up time.
2. Stay 5 Giant steps away from the road
3. Wait for the driver to signal you before you cross the street.
4. Always use the handrail when getting on and off the bus
5. Quickly find your seat.
6. Sit seat-to-seat and back-to-back.
7. Always keep your hands to yourself.
8. Talk quietly on the bus
9. Keep everything in your book bag and dont get anything out on the bus
10. Wait for the bus to come to a complete stop before standing to exit the bus one
seat at a time.
11. Always get the attention of the bus driver before bending over to pick up
something you have dropped.
12. If you miss the bus do not ever chase it, or have your parents follow behind it, in
their car. Have your parents drive you to school; it is much too dangerous to run
up alongside the bus.
13. The driver has the right to assign seats.
14. Obey all directions/instructions the driver gives you.

Items not allowed on the bus
Pets (alive or dead)
Toys (of any size)
Glass items
Balloons
Weapons (including sharp objects, Pencils are allowed, they should be
kept in the book bag.)
Illegal drugs and alcohol
Food and Drink (including gum, candy and suckers should not be out or
eaten while on the bus, they may be carried in the book bag or lunch
box)
Any items too large to fit into seat or be held on your lap.
C. The following acts of serious misconduct on the bus or violations of safety
Rules and practices listed in Section B may result in Bus Suspensions:
1. Damage to bus property.
2. Fighting.
3. Use of real or imitation tobacco products.
4. Profanity.
5. Use of fire or open flame.
6. Use of drugs (including alcohol).
7. Bullying

Hardin County School buses are equipped with video camera security boxes. Video
cameras are moved from bus to bus monitoring behavior and student management
procedures.



SCHOOL TRIPS: OVERNIGHT

GUIDELINES FOR STUDENTS ATTENDING OVERNIGHT SCHOOL
EVENTS/TRIPS:

The criteria listed below will be used to guide teachers when making recommendations on a
students participation on a school sponsored overnight trip and/or event.

1. Suspension from school.
2. Violation of the current Hardin County Code of Conduct and/or G. C. Burkheads
Discipline Plan.
3. Hitting or striking fellow students or school personnel.
4. Being called to the principal or assistant principals office for disciplinary action during
the school year for any of the following:
Failure of student to follow directives of school personnel
Destruction of school property
Being disrespectful toward teachers
Use of profane language
Transportation problems involving Hardin Co. School Buses during the regular
school day
A final discussion concerning the students attendance will be held between the teacher and the
principal/assistant principal. When the decision is made, a conference will be
held involving the parent, the students teacher, and principal/assistant principal. Disruptive
behavior by the student on the overnight school sponsored event/trip will result in the student
being sent home. The parent(s) will be responsible for all arrangements to transport their child
home



SAFE SCHOOL POLICY
To ensure the safety of all GCB students, and to facilitate the dismissal of students at the close of
the school day, the following procedures will be implemented, monitored, and enforced:
All visitors (including parents of enrolled students) will be required to first report to the
office and sign in and obtain visitors pass.
Students that check out before the bell must be signed out through the office first. This
prevents unauthorized persons from picking up a student.
Students who are transported by their parents in the afternoon will be released to the
library for pick-up. Photo identification must be made available.
Adults seen in the building, other than regular staff, will be asked their purpose for being
there, should any direction be needed.
All doors will remain locked excluding the front door entry to the center building.
All students leave and return to their classrooms either in pairs or groups under staff
supervision. Students will travel from building to building through the cafeteria.
Should any emergency arise, there are plans in place for appropriate staff response.



FIRE DRILLS
Fire drills will be held once a month except for the first two weeks of school, when there will be
two. Students, under the teachers supervision, are to exit the building according to drill
procedures. Turn out the lights and close the classroom door. Have in your possession the
student roll outside to be sure all students are accounted for. Please notify the Assistant Principal
if fire exit routes for both primary and secondary are not posted in your room.

TORNADO DRILLS
Tornado drills will be held during the months of August and January and as needed.
Proceed to designated areas where students should sit with their heads
Between their knees and their heads covered. Please notify the Assistant Principal if tornado
shelter areas are not posted in your room.

EARTHQUAKE DRILLS
Two earthquake drills will be held during August and January. Instruct students to DROP and
COVER. Students should get under a sturdy table or desk.




REFER TO THE GCB EMERGENCY MANAGEMENT PLAN FOR:

LOCKDOWN DRILLS AND PROCEDURES

INTRUDER DRILLS AND PROCEDURES

BOMB THREAT


EVACUATION TIME KEEPER FOR DRILLS:

BUILDING TIME KEEPER ALTERNATE
West Ott Crim
North Rivera Goodwine
South Nichols Sherrard
East Goodman Isaacs
Center B. Kerr Epperson
Upper Middle Wooldridge Will



MASTER EVACUATION ROUTES

WEST BUILDING Go to the front parking lot in front of the GCB sign.

CENTER BUILDING Go to the front parking lot in front of the GCB sign.

UPPER MIDDLE Go to the hillside/far parking lot close to apartments.

NORTH BUILDING Go to the hillside/far parking lot close to apartments.

SOUTH BUILDING Go to the field behind the gym as far from the school without getting too
close to the road.

EAST BUILDING Go to the field behind the gym as far from the school without getting too
close to the road

CENTER BUILDING PRINCIPAL
EAST BUILDING ASSISTANT PRINCIPAL
UPPER MIDDLE HOLLY MOBERLY
WEST BUILDING HOLLY MOBERLY
NORTH BUILDING LORI INDALECIO
SOUTH BUILDING DAYTIME CUSTODIAN








ACCIDENTS/INJURIES/ILLNESSES
G.C. Burkhead has an excellent record in regard to the safety of its students. Your conscientious
efforts involving injuries and illnesses are to be commended.
It shall be the responsibility of teachers or other employees to report accidents or injuries that
occurred on the school grounds to the principal or someone designated by the principal. A
decision will be made by the person(s) to whom it was reported whether to contact the
parent/guardian or to make an emergency doctor or hospital visit if the injury requires it.
Accidents requiring either parent notification or a doctor/hospital visit shall be reported on the
School Accident Form. In case of serious accident, the Superintendent or a member of the
Central Office staff shall be notified as soon as possible. The Safety Committee shall make
yearly evaluations of accidents and accident forms will be turned into the Central Office at the
end of the year.
Students who become ill during the school day should be sent to the office, and office personnel
will determine whether the parents should be called or the child needs the attention of the school
nurse.

G.C. BURKHEAD POLICY FOR HEAD LICE CONTROL
HEAD LICE POLICY
.
Any G. C. Burkhead student found to have live head lice will have a responsible adult called
and will be returned home as soon as possible. If no one can be reached, the child will be sent
home the usual time with a letter. The child must then be returned to school by an adult for a
recheck. The child may return to school without an adult only if a note from a health professional
indicates the child ok to return to school.
If a student is found to have head lice, all efforts will be made to prevent the spread of lice to
other students in the classroom. For example, coats and other personal items may be stored
separately, and classroom activities may be changed temporarily to reduce close contact among
students. In addition, all heads in the room will be checked, including staff members.


MEDICATION
All medications, which are to be administered to a student at school, should be kept in the office
and proper paperwork must be completed before medicine is administered. A written
authorization form must accompany any medication given on a long-term basis and these forms
are kept on file in the office.