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YPS PROVIDER ATTESTATION AND PARENT PERMISSIONS FOR INDEPENDENT MEDICATION CARRY AND USE Directions for the Health Care Provider: This form may be used as an addendum to a medication order which does
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How to fill out self-carry and self-administer medication

01
Consult with your healthcare provider to determine if self-carry and self-administer medication is appropriate for your condition.
02
Receive proper training on how to correctly administer the medication.
03
Keep the medication in a secure and easily accessible location.
04
Follow the prescribed dosage and schedule for taking the medication.
05
Keep a record of when you take the medication to track your progress and ensure you don't miss any doses.

Who needs self-carry and self-administer medication?

01
Individuals who have been prescribed medications that require immediate administration in case of emergencies, such as EpiPens for allergies or rescue inhalers for asthma.
02
Patients with chronic conditions that require frequent medication doses throughout the day, such as diabetes or certain autoimmune disorders.
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Self-carry medication refers to the practice where individuals are allowed to keep their medication with them for personal use, while self-administer medication means the individual is responsible for taking the medication themselves, as per their medical needs.
Individuals who have been prescribed medication that they are allowed to carry and administer themselves, typically those with chronic health conditions or specific medical needs, must file self-carry and self-administer medication.
To fill out self-carry and self-administer medication forms, individuals need to provide personal information, details of the medication, dosage instructions, the prescribing physician’s information, and any relevant medical history.
The purpose of self-carry and self-administer medication is to empower patients with the responsibility of managing their health by allowing them to carry and take necessary medication as needed, enhancing their quality of life.
Required information typically includes the patient's name, the name of the medication, dosage, frequency of administration, prescribing doctor’s details, and any specific conditions for use.
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