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Superintendent File: JLCDE1Student Medication Request and Release Agreement Student: DOB: School Year Name of Medication Epinephrine Auto Injector* *If Colorado State Anaphylaxis Health Care Plan
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What is student medication request?
Student medication request is a form used to request medication administration for students who require medication during school hours.
Who is required to file student medication request?
Parents or guardians are required to file student medication request on behalf of their child.
How to fill out student medication request?
To fill out student medication request, parents or guardians must provide information about the student, the medication to be administered, dosages, and any potential side effects.
What is the purpose of student medication request?
The purpose of student medication request is to ensure that students receive necessary medication in a safe and timely manner while at school.
What information must be reported on student medication request?
Information that must be reported on student medication request includes student's name, date of birth, health condition requiring medication, medication name, dosage, frequency of administration, and emergency contact information.
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