Get the free medication authorization form - Milwee Middle School
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EXHIBITDescriptor Code: ACBDE2
AUTHORIZATION/PARENTAL CONSENT
FOR SCHOOL TO PROVIDE MEDICATION OR
STUDENT TO SELFADMINISTER MEDICATIONNOTE: Use a separate authorization form for each medication. Provide
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How to fill out medication authorization form
How to fill out medication authorization form
01
Obtain a medication authorization form from the healthcare provider or pharmacy.
02
Read and understand the instructions on the form.
03
Provide your personal information including name, address, date of birth, and contact details.
04
Mention the medication name, dosage, and frequency as prescribed by the healthcare provider.
05
Specify any allergies, if applicable.
06
Indicate the reason for taking the medication.
07
Mention any other medications being currently taken or any important medical history.
08
If required, provide the name and contact information of the healthcare provider.
09
Sign and date the form at the designated area.
10
Submit the completed form to the healthcare provider or pharmacy as instructed.
Who needs medication authorization form?
01
Anyone who requires medication and needs to authorize its usage can fill out a medication authorization form. This can include patients who regularly take prescription medications, individuals requiring special medications or treatments, those with chronic illnesses, and individuals who need medication administration in specific settings, such as schools, nursing homes, or workplaces.
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