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SOUTHEAST LOCAL SCHOOL DISTRICT EMERGENCY MEDICAL AUTHORIZATION (Use Black Ink) Please check here if any of the information below has changed from the previous school year. Student Name Home Phone
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How to fill out student emergency medical authorization
How to fill out student emergency medical authorization:
Gather necessary information:
01
Full name of the student
02
Date of birth of the student
03
Contact information of the student's parents or guardians
04
Emergency contact information for someone who is not a parent or guardian
Provide medical history:
01
Indicate any existing medical conditions or allergies that the student has.
02
Include information about any medications the student takes regularly.
Emergency medical treatment preferences:
01
Specify any known medical treatments that the student prefers or requires.
02
Include any instructions or preferences for medical professionals in case of an emergency.
Sign and date the form:
01
As the student's parent or guardian, sign and date the form in the designated spaces.
02
Ensure that all information provided is accurate and complete.
Who needs student emergency medical authorization:
01
Any student who participates in school activities, including field trips, sports events, or extracurricular activities, may require a student emergency medical authorization.
02
It is crucial for parents or guardians to complete this form to ensure that appropriate medical care can be provided if an emergency occurs while the student is under school supervision.
03
The student emergency medical authorization form allows the school to access vital medical information and contact the appropriate individuals in case of an emergency.
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What is student emergency medical authorization?
Student emergency medical authorization is a document that gives permission for medical treatment in case of an emergency involving a student.
Who is required to file student emergency medical authorization?
Parents or legal guardians of the student are required to file student emergency medical authorization.
How to fill out student emergency medical authorization?
To fill out student emergency medical authorization, parents or legal guardians need to provide personal information, emergency contact details, healthcare provider information, and consent for medical treatment.
What is the purpose of student emergency medical authorization?
The purpose of student emergency medical authorization is to ensure that appropriate and timely medical treatment can be provided to a student in case of an emergency.
What information must be reported on student emergency medical authorization?
Student's personal information, emergency contact details, medical history, healthcare provider information, and consent for medical treatment must be reported on student emergency medical authorization.
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