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Spring Branch Independent School District HEALTH SERVICES Parents Statement for Administration of Nonprescription Medication Students Name Birthdate School Grade I am requesting that the following

How to fill out medication - nonprescription form

How to fill out a medication - nonprescription form:

1. Start by providing your personal information such as your full name, date of birth, and contact details.
2. Indicate the name of the medication you are requesting and the dosage you require. If you are unsure, consult with a pharmacist before filling out the form.
3. List any existing medical conditions or allergies that you have, as well as any medications you are currently taking. It is important to disclose this information for your safety.
4. Specify the reason why you need the medication, whether it is for pain relief, cold and flu symptoms, or any other specific condition. This will help the pharmacist assess your needs better.
5. Indicate whether you have previously taken the same medication and if it has worked for you. This information can help the pharmacist determine the best course of action.
6. Sign and date the form to acknowledge that the information you have provided is accurate and complete.

Who needs a medication - nonprescription form?

1. Anyone who wants to purchase nonprescription medication for self-use would typically need to fill out a medication - nonprescription form.
2. Individuals who have specific medical conditions or are taking other medications may need to fill out this form to ensure that the nonprescription medication they intend to use is safe and suitable for their needs.
3. It is especially important for individuals with allergies or known adverse reactions to certain medications to fill out this form, as it allows healthcare professionals to provide appropriate guidance and recommendations.

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