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This document is a request form for parents and physicians to authorize the administration of medication to a student by school personnel during school hours.
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How to fill out physician and parent request

How to fill out PHYSICIAN AND PARENT REQUEST FOR THE ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL
01
Obtain the PHYSICIAN AND PARENT REQUEST FOR THE ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL form from the school.
02
Fill in the student's personal information at the top of the form, including name, date of birth, and grade.
03
Provide details about the medication, including the name, dosage, and frequency of administration.
04
Include specific instructions for administration, such as how the medication should be given and any potential side effects.
05
Have the physician complete the relevant sections, including their signature, date, and contact information.
06
The parent or guardian should then sign the form, confirming their request for the administration of medication.
07
Submit the completed form to the school’s administration or designated personnel.
Who needs PHYSICIAN AND PARENT REQUEST FOR THE ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL?
01
Students who require medication during school hours, as prescribed by a physician.
02
Parents or guardians of those students who need to authorize the administration of medication.
03
School personnel who are responsible for administering medications to students.
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People Also Ask about
What are the 5 rules for the administration of medication?
Most health care professionals, especially nurses, know the “five rights” of medication use: the right patient, the right drug, the right time, the right dose, and the right route — all of which are generally regarded as a standard for safe medication practices.
What is an example of a Medication Administration policy?
Medication in plastic bags or other non-original containers will not be accepted or administered. All sample medications (including inhalers) dispensed by doctors must be accompanied by the physician's written authorization/prescription for the administration of the medication.
What are the 7 rules of administering medication?
Follow the Seven Rights when you are administering medication to the individuals you support: Right Person, Right Medication, Right Dose, Right Time, Right Route, Right Reason, and Right Documentation.
What are the requirements around administering medication to a child?
Labels should show: The child's name. The name of the medication. Dosage to be taken. Time it should be taken. Route of administration: by mouth, inhaler, injection, etc. The prescriber's name. Prescription date. Medication expiration date.
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What is PHYSICIAN AND PARENT REQUEST FOR THE ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL?
It is a form that allows parents and physicians to request that school personnel administer medication to a student during school hours.
Who is required to file PHYSICIAN AND PARENT REQUEST FOR THE ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL?
The form must be filed by the parent or guardian of the student, along with a licensed physician's order.
How to fill out PHYSICIAN AND PARENT REQUEST FOR THE ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL?
The form should be filled out by providing detailed information including the student's name, medication name, dosage, frequency, and both the parent's and physician's signatures.
What is the purpose of PHYSICIAN AND PARENT REQUEST FOR THE ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL?
The purpose is to ensure that students who require medication during school hours receive it safely and in accordance with medical advice.
What information must be reported on PHYSICIAN AND PARENT REQUEST FOR THE ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL?
The form must report the student's name, date of birth, medication details (name, dosage, and schedule), any side effects, and emergency contact information.
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