Get the free Asthma Medication Authorization Form

This form is required for students with asthma to either self-administer asthma medications or verify that they do not need to carry medication at school. It includes sections for parental authorization

How to fill out asthma medication authorization form

How to fill out Asthma Medication Authorization Form

1. Obtain the Asthma Medication Authorization Form from your healthcare provider or school.
2. Fill in the patient's name and date of birth at the top of the form.
3. Provide the name of the prescribing physician and their contact information in the designated section.
4. List the specific asthma medications that the patient will be using - include dosage and frequency.
5. Indicate whether the medication is for emergency use or daily management.
6. If required, provide details regarding administration routes (e.g., inhaler, nebulizer).
7. Sign and date the form where indicated, confirming that all information provided is accurate.
8. Submit the completed form to the school nurse or appropriate administrator.

Who needs Asthma Medication Authorization Form?

1. Students with asthma who require medication during school hours.
2. Parents or guardians of children who use asthma medication.
3. Schools or educational institutions that must manage students' asthma adequately.
4. Healthcare providers who prescribe asthma medications to patients in school settings.

For pdfFiller’s FAQs

What is Asthma Medication Authorization Form?

The Asthma Medication Authorization Form is a document that allows schools or childcare facilities to keep and administer asthma medications to students who have a diagnosed asthma condition.

Who is required to file Asthma Medication Authorization Form?

The form is typically required to be filed by parents or guardians of students who have asthma and need to take asthma medication during school hours.

How to fill out Asthma Medication Authorization Form?

To fill out the form, provide the child's personal information, details about the asthma diagnosis, prescribed medication, dosage, and administration instructions, and obtain signatures from both a parent and a healthcare provider.

What is the purpose of Asthma Medication Authorization Form?

The purpose of the form is to ensure that students with asthma receive their necessary medications safely and in compliance with school policies, while also safeguarding the school from liability.

What information must be reported on Asthma Medication Authorization Form?

The form must include the student's name, date of birth, emergency contact information, details of the asthma diagnosis, medication name and dosage, administration route, and any other relevant medical information.