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164 South Prospect Avenue Park Ridge, IL 60068 (847) 3184300 F (847) 3184351 d64.preschool Medication Authorization Form Student name Address Schoolgirl date Telephone Grade/Room To be completed by

How to fill out school medication authorization form

How to fill out school medication authorization form

1. Read and understand the instructions provided on the school medication authorization form.
2. Fill out the student's personal information section, including their full name, date of birth, and grade level.
3. Indicate the name of the medication that needs to be administered to the student at school.
4. Specify the dosage and frequency of the medication.
5. Provide any special instructions or notes regarding the medication's administration.
6. If the medication requires specific storage conditions or needs to be refrigerated, mention it in the form.
7. Include any known allergies or adverse reactions the student may have to medication.
8. Provide emergency contact information, including the name, phone number, and relationship of the contact person.
9. Make sure to sign and date the form to acknowledge your consent and agreement with the medication administration terms.

Who needs school medication authorization form?

1. Any student who requires medication to be administered during school hours needs to fill out the school medication authorization form.
2. This includes students with chronic illnesses, allergies, asthma, diabetes, epilepsy, or other medical conditions where medication needs to be administered at specific times.

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What is school medication authorization form?

The school medication authorization form is a document that allows a licensed healthcare provider to prescribe medication for a student during school hours, ensuring that the administration of the medication is conducted legally and safely.

Who is required to file school medication authorization form?

Parents or guardians of students who require medication during school hours must file the school medication authorization form, along with a licensed healthcare provider's signature.

How to fill out school medication authorization form?

To fill out the school medication authorization form, parents should provide the student's personal information, the medication details, dosage instructions, and have it signed by a healthcare provider before submitting it to the school.

What is the purpose of school medication authorization form?

The purpose of the school medication authorization form is to ensure that students can receive necessary medications during school hours while complying with school policies and legal regulations.

What information must be reported on school medication authorization form?

The form must report the student's name, date of birth, medication name, dosage, administration route, times to be administered, potential side effects, and the healthcare provider's contact information.