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SUN PRAIRIE AREA SCHOOL DISTRICT 501 South Bird Street Sun Prairie, WI 53590 STUDENT SELF-ADMINISTER MEDICATION FORM FOR STUDENTS GRADES 10-12 Student name: Phone # Parent/Guardian name: School: Grade:
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How to fill out student self-administer medication form
How to fill out student self-administer medication form:
01
Obtain the form from the school or healthcare provider. It is usually available on the school's website or can be provided by the nurse's office.
02
Fill in the personal information section, including the student's name, date of birth, grade level, and contact information.
03
Provide details about the medication being self-administered. This includes the name of the medication, dosage instructions, and any specific precautions or side effects.
04
Indicate the times and frequency at which the medication should be taken, as well as any specific instructions for administration, such as with food or water.
05
If necessary, include information about storage requirements for the medication, such as keeping it refrigerated or protected from heat and sunlight.
06
If the student has any known allergies or medical conditions, provide this information on the form for the healthcare provider's reference.
07
Sign and date the form, indicating that you understand and agree to the terms and conditions outlined in the form.
08
Return the completed form to the designated person or office at the school, such as the nurse's office, for processing and approval.
Who needs student self-administer medication form:
01
Students who require prescription medication during school hours and are capable of self-administration may need to fill out a student self-administer medication form.
02
This form ensures that the school is aware of the medication being taken and allows for proper monitoring and supervision if necessary.
03
It is important for students with chronic conditions, such as asthma or diabetes, to have this form on file to ensure their safety and well-being while at school.
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What is student self-administer medication form?
The student self-administer medication form is a document that allows students to self-administer medication at school under certain conditions.
Who is required to file student self-administer medication form?
Students who need to self-administer medication at school are required to file the student self-administer medication form.
How to fill out student self-administer medication form?
To fill out the student self-administer medication form, students need to provide information about the medication, dosage, timing, and any special instructions from their healthcare provider.
What is the purpose of student self-administer medication form?
The purpose of the student self-administer medication form is to ensure that students can safely self-administer their medication at school and have proper documentation on file.
What information must be reported on student self-administer medication form?
Information such as the student's name, the name of the medication, dosage, timing, healthcare provider's instructions, and emergency contacts must be reported on the student self-administer medication form.
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