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DORCHESTER SCHOOL DISTRICT TWO 20232024 AUTHORIZATION FOR TELEMONITORING OR MALADMINISTRATION OF MEDICATION The following is to be completed by a physician/legal prescriber. One medication and/or
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How to fill out authorization for self medication
How to fill out authorization for self medication
01
Start by providing your personal information such as name, address, and contact details.
02
Specify the medications you are authorized to self-administer by listing them clearly with dosage instructions.
03
Include any relevant medical conditions or allergies that should be taken into consideration.
04
Sign and date the authorization form to confirm your understanding and consent.
05
If necessary, have a healthcare provider or physician review and approve the authorization for self-medication.
Who needs authorization for self medication?
01
Individuals who require regular medication and are capable of self-administering it safely.
02
Patients with chronic conditions who need to have their medication accessible at all times.
03
Students and employees who may need to take medication during school or work hours.
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What is authorization for self medication?
Authorization for self medication is a document that allows an individual to take certain medications without a prescription.
Who is required to file authorization for self medication?
Any individual who wishes to self medicate with certain medications must file for authorization.
How to fill out authorization for self medication?
To fill out authorization for self medication, one must provide their personal information, medical history, and the specific medications they are seeking authorization for.
What is the purpose of authorization for self medication?
The purpose of authorization for self medication is to ensure that individuals are safely and responsibly using certain medications without a prescription.
What information must be reported on authorization for self medication?
Information such as personal details, medical history, and the specific medications being requested must be reported on the authorization form.
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