Cornwall Central High School

As part of our efforts to keep students safe and healthy during the school day, the New York State Education Department requires a patient-specific order from a healthcare provider for any topical over-the-counter (OTC) products used in school, including items such as vaseline, ointments, antiseptic wipes, and aloe vera gel. To ensure your child can safely receive topical OTC products at school, please complete the Healthcare Provider Authorization Form.

Important Reminders:

• This authorization must be completed annually to remain valid.
• Topical OTC supplies cannot accompany a student on field trips or any off-campus activities
• The form is not valid without both the parent/guardian and healthcare provider signatures
• Completed forms will be added to your child’s health record at school.

Once completed, please return the form to the school nurse in your child’s building. Thank you for your attention to this important requirement. Ensuring your child has proper authorization for topical OTC products helps us keep all students safe and supported throughout the day. 

The document is available for download below, or you may click here for fax numbers or to contact your child’s school health office for a copy of this form.