
Get the free PRESCRIPTION MEDICATION SELF-ADMINISTRATION CONSENT FORM - wolsey-wessington k12 sd
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Grades 612SCHOOL HEALTH SERVICESPRESCRIPTION MEDICATION MALADMINISTRATION CONSENT FORM
(PHYSICIANS SIGNATURE REQUIRED)Requires renewal at the beginning of each school rename of Student
Address
Parent/Guardian
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How to fill out prescription medication self-administration consent

How to fill out prescription medication self-administration consent
01
Obtain the prescription medication self-administration consent form from a healthcare provider or pharmacy.
02
Read the form carefully and understand the terms and conditions.
03
Fill out the form accurately, providing all necessary personal information like name, date of birth, address, and contact details.
04
Write down the name and dosage of the medication you have been prescribed.
05
Indicate the frequency and time of day for taking the medication.
06
If there are any special instructions or precautions, mention them on the form.
07
Sign and date the form, certifying that you understand the risks and responsibilities of self-administering the medication.
08
Submit the completed form to the relevant authority or keep a copy for your records.
Who needs prescription medication self-administration consent?
01
Prescription medication self-administration consent is required by individuals who are responsible for managing their medication intake without the direct supervision of a healthcare professional.
02
This form is particularly relevant for patients who are prescribed long-term medications or those who need to take medication in specific situations such as emergencies or when traveling.
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