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ALABAMA STATE DEPARTMENT OF EDUCATIONSCHOOL MEDICATION PRESCRIBER/PARENT AUTHORIZATION School Year: 2016 2017 STUDENT INFORMATION Students Name: School: Gestate of Birth: / / Grade: Teacher: Age:
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01
Start by carefully reviewing the instructions provided on the over form counter prescriber.
02
Fill in your personal information accurately, including your name, address, and contact details.
03
Provide any necessary medical history or condition information as required.
04
Clearly indicate the date and any other relevant dates on the form.
05
Carefully fill out the details of the prescribed medication, including the name, dosage, and frequency of use.
06
If applicable, include the name and contact information of the prescribing physician.
07
Double-check all the information you have filled in to ensure accuracy.
08
Sign and date the form, confirming that the information provided is true and accurate.
09
Keep a copy of the completed form for your records and submit the original to the designated recipient.
Who needs over form counter prescriber?
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The over form counter prescriber is typically needed by individuals who require over-the-counter medications, but still need a prescription from a medical professional.
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This could include individuals with certain medical conditions that require monitoring or those who may have a history of allergies or adverse reactions to medications.
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It is important to consult with a healthcare provider to determine if the use of an over form counter prescriber is necessary in your specific case.
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