Get the free Authorization for Self-Carry/Administration of Medication - brentwoodpgh k12 pa
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This document authorizes a responsible, trained student to carry and/or self-administer medication at school and after-school activities, with necessary approvals.
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How to fill out authorization for self-carryadministration of
How to fill out Authorization for Self-Carry/Administration of Medication
01
Obtain the Authorization for Self-Carry/Administration of Medication form from the school or healthcare provider.
02
Fill in your personal information, including your name, address, date of birth, and any relevant identification numbers.
03
Provide details of the medication, including the name, dosage, and frequency of administration.
04
Include specific instructions for when and how to take the medication, along with any emergency procedures if necessary.
05
Have your parent or guardian sign the form to confirm their consent for self-carry/administration.
06
Obtain a healthcare professional's signature, if required, to validate the need for self-administration.
07
Submit the completed form to the school nurse or designated authority at the school.
Who needs Authorization for Self-Carry/Administration of Medication?
01
Students who require medication during school hours and wish to carry it with them.
02
Individuals with chronic health conditions that necessitate self-administration of medications.
03
Students with allergies or other medical conditions that require immediate access to their medication.
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What is Authorization for Self-Carry/Administration of Medication?
Authorization for Self-Carry/Administration of Medication is a formal permission that allows a student to carry and manage their own medication during school hours or school-related activities.
Who is required to file Authorization for Self-Carry/Administration of Medication?
Typically, students who require medication during school hours, particularly those with chronic conditions or disabilities, are required to file this authorization, often with the support of their parents or guardians.
How to fill out Authorization for Self-Carry/Administration of Medication?
To fill out the Authorization for Self-Carry/Administration of Medication, the student and their parent or guardian must complete the form, providing necessary details including the student's name, the medication name, dosage, times to be taken, and any special instructions. It must also be signed by a physician.
What is the purpose of Authorization for Self-Carry/Administration of Medication?
The purpose of this authorization is to ensure that students are able to safely manage their medication needs while at school, promoting their independence and ensuring their health and safety.
What information must be reported on Authorization for Self-Carry/Administration of Medication?
The form must report the student's name, the name of the medication, the prescribed dosage, administration times, the reason for the medication, any potential side effects, emergency contact information, and appropriate signatures from both a physician and a parent or guardian.
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