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CURRICULA COUNTY SCHOOLS Permission and Contract for SelfCarried and SelfAdministered Medication STUDENTS NAME:___ DATE:___ SCHOOL:___TEACHER/GRADE:___ PARENT SIGNATURE: ___ PHONE:___ PHYSICIANS SIGNATURE:
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How to fill out self carry and administer

01
Start by gathering all the necessary materials for self carry and administer.
02
Ensure you have the correct dosage of medication prescribed by your healthcare professional.
03
Wash your hands thoroughly with soap and water before starting the process.
04
Use a clean and sterile needle to draw the medication from its container.
05
Clean the injection site with an alcohol swab and let it dry completely.
06
Pinch the skin at the injection site to create a small fold.
07
Hold the syringe like a dart, with the bevel of the needle pointing upwards.
08
Insert the needle swiftly and firmly into the skin at a 90-degree angle.
09
Slowly push the plunger down to inject the medication.
10
Once the medication is fully injected, swiftly remove the needle from the skin.
11
Dispose of the used needle and syringe in a sharps container.
12
Apply gentle pressure to the injection site with a cotton ball or tissue.
13
If necessary, cover the injection site with a bandage.
14
Discard any unused medication properly.
15
Wash your hands again thoroughly after completing the process.

Who needs self carry and administer?

01
Self carry and administer is typically needed by individuals who require regular medication injections at home.
02
This may include individuals with chronic conditions such as diabetes, autoimmune disorders, or hormone deficiencies.
03
It is important to consult with a healthcare professional to determine if self carry and administer is appropriate for your specific situation.
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Self carry and administer refers to the act of an individual carrying and administering medication or treatment to themselves without the assistance of a healthcare professional.
Individuals who need to self carry and administer medication or treatment are required to file the necessary documentation.
To fill out self carry and administer, individuals need to provide information about the medication or treatment, dosage, frequency of administration, and any potential side effects.
The purpose of self carry and administer is to ensure that individuals can safely and effectively administer necessary medication or treatment to themselves.
Information such as the name of the medication or treatment, dosage, frequency of administration, potential side effects, and any allergies must be reported on self carry and administer documentation.
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