Get the free Asthma Medication Authorization Form

This form is required for students with asthma to authorize self-administration of asthma medications at Saint Xavier High School and ensures compliance with Kentucky House Bill 353 regarding asthma

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 individuals, typically students, to use prescribed asthma medication during school hours or while participating in school activities.

Who is required to file Asthma Medication Authorization Form?

Parents or guardians of students who have asthma and require medication during school hours are required to file the Asthma Medication Authorization Form.

How to fill out Asthma Medication Authorization Form?

To fill out the Asthma Medication Authorization Form, provide the student's personal information, the details of the asthma medication, the prescribing physician's information, and obtain signatures from both the parent/guardian and the physician.

What is the purpose of Asthma Medication Authorization Form?

The purpose of the Asthma Medication Authorization Form is to ensure that school staff are authorized to administer asthma medication to students in a safe and legal manner.

What information must be reported on Asthma Medication Authorization Form?

The form must include the student's name, date of birth, medication name, dosage, frequency of administration, emergency contact information, and signatures from the parent/guardian and the prescribing physician.