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Serra Catholic High School PARENT/GUARDIAN AND PHYSICIAN REQUEST FOR MEDICATION ADMINISTRATION Name of Student: Date: Birthdate: Grade: PARENT/GUARDIAN REQUEST FOR THE ADMINISTRATION OF MEDICATION
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How to fill out parent physician request for
How to fill out parent physician request for:
01
Start by providing your personal information, including your full name, address, phone number, and email address. Make sure to write legibly and provide accurate contact information.
02
Next, indicate the purpose of your request. Specify that you are requesting a parent physician form and provide the reasons for your request. This could include situations such as allowing your child to receive specific medical treatments or medications at school.
03
Include your child's information, such as their full name, date of birth, and current grade or class. This will help the physician identify the correct student and provide appropriate medical recommendations.
04
Provide any necessary medical history or relevant information regarding your child's health condition. Mention any allergies, pre-existing medical conditions, or medications they are currently taking. This information will assist the physician in making informed decisions.
05
Specify the duration of the requested medical authorization. State whether this is a one-time request or if it applies for a specific period, such as the entire school year.
06
Sign and date the form to validate your request. Make sure to read through the entire form before signing to ensure accuracy and completeness.
07
Submit the completed form to the appropriate school personnel or designated authority. Follow any additional instructions or guidelines provided by the school or healthcare facility.
Who needs parent physician request for:
01
Parents or legal guardians who have children with specific medical needs or conditions that require ongoing medical treatment or medication during school hours.
02
Parents who want to authorize the school to have access to their child's medical records or allow the administration of specific medical treatments while at school.
03
Parents who wish to provide detailed information about their child's medical history or conditions, ensuring that school personnel are aware and prepared to handle any potential medical emergencies.
Remember, the parent physician request form serves as a communication tool between parents, physicians, and school authorities. It helps ensure the safety and well-being of the child while at school, providing necessary medical information and authorizations.
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What is parent physician request for?
Parent physician request is for requesting medical treatment for a minor child.
Who is required to file parent physician request for?
The legal parent or guardian of the minor child is required to file the parent physician request.
How to fill out parent physician request for?
Fill out the form with the child's information, medical condition, treatment requested, and parent/guardian signature.
What is the purpose of parent physician request for?
The purpose is to authorize medical treatment for a minor child when the parent/guardian is not present.
What information must be reported on parent physician request for?
The child's name, date of birth, medical condition, treatment requested, parent/guardian contact information.
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