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Sarasota County School Health Services MEDICATION/TREATMENT AUTHORIZATION FORM Students Name Sex Grade Date of BirthSchool Name FAX Number following section is to be completed by the parent or legal
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How to fill out medication treatment authorization form
How to fill out medication treatment authorization form
01
Step 1: Start by obtaining a copy of the medication treatment authorization form from the relevant healthcare provider or facility.
02
Step 2: Read the instructions on the form carefully to understand the information required.
03
Step 3: Fill in your personal details accurately, including your name, address, date of birth, and contact information.
04
Step 4: Provide information about the medication being authorized, such as the name, dosage, frequency, and duration of treatment.
05
Step 5: If applicable, provide details about any allergies or medical conditions that may affect the use of the medication.
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Step 6: Sign and date the form to authorize the treatment and acknowledge your understanding of the potential risks and benefits.
07
Step 7: Submit the completed form to the healthcare provider or facility as instructed.
Who needs medication treatment authorization form?
01
Individuals who require medication treatment from a healthcare provider or facility may need to fill out a medication treatment authorization form.
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