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AUTHORIZATION TO ADMINISTER MEDICATION IN SCHOOL (To be kept confidential upon completion) Name of Student: DOB: Grade: Diagnosis×Illness: Medication: Dosage×Route: Frequency: Special Directions:

How to fill out authorization to administer medication

How to fill out authorization to administer medication:

1. Start by providing your personal information, including your full name, contact details, and any relevant credentials or certifications you possess in the healthcare field.
2. Next, specify the name and contact information of the person or organization that you will be administering medication to. This could be a patient, a student if you're a school nurse, or a client if you work in a healthcare facility.
3. Clearly state the purpose of the authorization, which is to grant you the legal permission and responsibility to administer medication to the designated individual.
4. Specify the types of medication that you are authorized to administer. This could include oral medications, injections, topical creams, or any other specific routes of administration.
5. Indicate the conditions or situations in which you are authorized to administer medication. For example, you might specify that you are only authorized to administer medication during regular business hours or in emergency situations.
6. Include any necessary limitations or restrictions on your authorization. For instance, you might mention that you are only authorized to administer medication for a specific period of time, or that you can only administer certain medications while under the supervision of a healthcare professional.
7. Finally, sign and date the authorization form, and ensure that the authorized individual or their legal guardian also signs and dates the document to acknowledge their consent.

Who needs authorization to administer medication:

1. Healthcare professionals: Doctors, nurses, pharmacists, and other licensed healthcare providers typically need authorization to administer medication as it ensures that they have the necessary knowledge and skills to safely administer drugs to patients.
2. School nurses: School nurses often require authorization to administer medication to students who may have specific medical needs or conditions that require regular medication administration during school hours.
3. Caregivers or family members: In certain situations, caregivers or family members may need authorization to administer medication to their loved ones at home. This is often the case for individuals with chronic illnesses or disabilities who require ongoing medication management.
4. Assisted living facility staff: Staff members in assisted living facilities or nursing homes may need authorization to administer medication to residents who are unable to do so themselves.

In general, anyone who is responsible for administering medication to another person should have the proper authorization to ensure they are qualified and capable of doing so safely and effectively.

For pdfFiller’s FAQs

What is authorization to administer medication?

Authorization to administer medication is a legal document that allows an individual to give medication to another person.

Who is required to file authorization to administer medication?

Healthcare professionals such as nurses, doctors, and caregivers are required to file authorization to administer medication.

How to fill out authorization to administer medication?

Authorization to administer medication can be filled out by providing the necessary personal information, medication details, dosage instructions, and any special instructions.

What is the purpose of authorization to administer medication?

The purpose of authorization to administer medication is to ensure that only qualified individuals are authorized to give medication and to provide a record of medication administration.

What information must be reported on authorization to administer medication?

Information such as the name of the individual receiving the medication, the name of the medication, dosage instructions, frequency of administration, and any special instructions must be reported on authorization to administer medication.

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