Get the free Authorization for Student Self-Medication Form - Lostant CUSD 425

Authorization for Student Self-Medication Form (Required if student has authorization to self-administer asthma medication and/or an Epinephrine Auto-Injector) School Year: Student’s Name: Birth

How to fill out authorization for student self-medication

How to fill out authorization for student self-medication:

1. Obtain the authorization form from the school administration or health office.
2. Fill in the student's name, grade, and other identifying information at the top of the form.
3. Provide the name and contact information of the student's parent or guardian.
4. Indicate any specific medical conditions or allergies that the student has.
5. Specify the medication(s) that the student is allowed to self-administer, including the dosage and frequency.
6. Clearly outline the procedures and instructions for the student to follow when administering the medication.
7. Have both the student and parent/guardian sign and date the authorization form.
8. Return the completed form to the school administration or health office.

Who needs authorization for student self-medication:

1. Any student who requires medication during school hours.
2. Students with chronic illnesses or medical conditions that may require emergency medication.
3. Students with allergies that may require immediate treatment.

For pdfFiller’s FAQs

What is authorization for student self-medication?

Authorization for student self-medication is a process that allows students to administer their own medication at school under certain conditions and with proper authorization.

Who is required to file authorization for student self-medication?

Parents or legal guardians of the student are required to file the authorization for student self-medication.

How to fill out authorization for student self-medication?

To fill out the authorization for student self-medication, the parents or legal guardians should provide information such as the student's name, prescribed medication details, dosage instructions, emergency contact information, and any specific procedures or considerations.

What is the purpose of authorization for student self-medication?

The purpose of the authorization for student self-medication is to ensure that students who require medication during school hours can safely and responsibly manage their own medication under proper supervision.

What information must be reported on authorization for student self-medication?

The authorization for student self-medication should include the student's name, prescribed medication details, dosage instructions, emergency contact information, and any specific procedures or considerations.

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