Get the free Emergency Medication Form for Secondary Students June 2017 (3).docx

BethlehemCentralSchoolDistrictHealthServicesEMERGENCYMEDICATION AUTHORIZATIONSFORSCHOOLADMINISTRATIONSuchemergencymedicationsincludeEpinephrine(forsevereallergies);Inhalers(for asthma);and, /Glucagon(for

How to fill out emergency medication form for

How to fill out emergency medication form for

1. Obtain a copy of the emergency medication form from a healthcare provider or download it from a credible source.
2. Read the instructions and requirements on the form carefully.
3. Fill in your personal information accurately, including your full name, date of birth, and contact information.
4. Provide details about your medical condition, such as allergies, chronic illnesses, or any existing medications you are currently taking.
5. Ensure that the emergency contact section is completed with the names and phone numbers of individuals who can be reached during an emergency.
6. If applicable, include information regarding your primary healthcare provider and any specific instructions they have given you for emergency situations.
7. Review the form thoroughly to ensure all information is accurate and complete.
8. Sign and date the form at the designated spaces.
9. Keep a copy of the form for your records and provide a copy to your healthcare provider or any relevant authorities as instructed.

Who needs emergency medication form for?

1. Emergency medication forms are typically needed by individuals who have a specific medical condition or require medications that may be critical during emergency situations.
2. Some examples of who may need an emergency medication form include:
3. - Individuals with severe allergies requiring immediate treatment with epinephrine
4. - Patients with chronic conditions such as diabetes, asthma, or epilepsy that may require specific medication or treatment during emergencies
5. - Individuals who rely on life-sustaining medications or medical devices
6. - Those who have recently undergone complex medical procedures or surgeries and may require emergency medication or treatment
7. It is important to consult with your healthcare provider to determine if you need an emergency medication form and what specific information should be included based on your medical situation.

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