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Golden Valley Charter School of Sacramento
Authorization for Medication Administration
Pursuant to Education Code section 49423, students required or needing medication (prescribed or overthecounter,
including
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How to fill out authorization for medication administration

How to fill out authorization for medication administration:
01
Begin by providing your personal information, including your full name, date of birth, and contact information.
02
In the next section, input details about your healthcare provider, such as their name, address, and phone number.
03
Specify the medication for which you are seeking authorization. Include the medication name, dosage, and any specific instructions.
04
Indicate the purpose of the medication and the duration of the authorization needed.
05
If applicable, provide any relevant medical history or conditions that may affect the administration of the medication.
06
Sign and date the authorization form to confirm your understanding and consent.
07
Submit the completed form to your healthcare provider for review and approval.
Who needs authorization for medication administration?
01
Patients who require medication administration outside of a healthcare facility may need authorization.
02
Individuals who are unable to self-administer medication due to physical or cognitive limitations may require authorization for assistance.
03
Some medications, such as controlled substances, may require additional authorization from a healthcare provider or regulatory agency.
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What is authorization for medication administration?
Authorization for medication administration is a written document that allows a healthcare provider to administer a specific medication to a patient.
Who is required to file authorization for medication administration?
Healthcare providers and facilities are required to file authorization for medication administration.
How to fill out authorization for medication administration?
Authorization for medication administration can be filled out by providing the patient's information, the medication details, dosage, time of administration, and any special instructions.
What is the purpose of authorization for medication administration?
The purpose of authorization for medication administration is to ensure the safe and appropriate administration of medications to patients.
What information must be reported on authorization for medication administration?
Authorization for medication administration must include the patient's name, date of birth, medical record number, medication name, dosage, route of administration, frequency, and any special instructions.
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