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PRESCRIBER AND PARENT REQUEST FOR THE ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL One medication per form Student Address City×State×Zip Name of Medication and Dosage Times of Day to be Administered

How to fill out prescriber and parent request

How to Fill Out Prescriber and Parent Request:

1. Begin by carefully reading the instructions provided on the prescriber and parent request form. It is essential to understand the specific requirements and guidelines before proceeding.
2. Provide all the necessary information accurately and completely. This includes details of the patient, such as their name, date of birth, and any relevant identification numbers. Additionally, include the contact details of the prescriber and the parent or legal guardian.
3. Clearly indicate the reason for the request. Specify whether it is for a medication refill, a new prescription, or any other purpose. Provide any relevant medical history or additional information that may support the request.
4. If applicable, attach any supporting documentation or medical records that may be crucial for the prescriber to review. This can provide further context and help them make an informed decision.
5. Review and double-check the completed form for any errors or omissions. Ensure that all the information is legible and accurate before submitting the request.

Who Needs Prescriber and Parent Request:

1. Prescribers: Prescriber and parent request forms are required by healthcare professionals authorized to prescribe medications. These professionals include physicians, nurse practitioners, or any other licensed healthcare provider responsible for the patient's care.
2. Parents or Legal Guardians: The parent or legal guardian of a minor patient may also need to fill out a prescriber and parent request form. This is usually to request a medication refill or a new prescription for their child.

Overall, prescriber and parent request forms play a crucial role in facilitating communication between healthcare professionals and parents or legal guardians. By following the proper guidelines and accurately filling out these forms, medication needs can be addressed efficiently and effectively.

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