Get the free Parent/Physician Request for Administration of Medication by School Personnel - risd
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2011-2012 HEALTH SERVICES Richardson Independent School District Parent/Physician Request for Administration of Medication by School Personnel Date of Request: School: Teacher/Grade: Student s Name:
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How to fill out parentphysician request for administration
How to fill out parentphysician request for administration:
01
Start by entering the date on the top right corner of the form.
02
Provide the student's name, grade, and date of birth in the designated fields.
03
Fill in the details of the medication to be administered. Include the name of the medication, dosage, and frequency.
04
Specify the purpose of the medication and any special instructions or precautions.
05
Indicate the start date and end date of the administration, if applicable.
06
Sign and date the form at the bottom, and provide any additional comments or instructions as necessary.
Who needs parentphysician request for administration:
01
Parents of students who require medication to be administered during school hours.
02
Physicians who need to provide written documentation of the medication and its administration instructions.
03
School administrators and nursing staff who need to review and authorize the administration of medication to students.
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