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RN ApprovalSCHOOL MEDICATION AUTHORIZATION ORDER STUDENT HEALTH PLANUtah Department of Health in Accordance with UCA 53G9501 PHOTO Do not use this form for Epinephrine AutoInjectors, Glucagon, Nursing
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How to fill out school administered medication authorization

How to fill out school administered medication authorization
01
Obtain the school administered medication authorization form from the school or school district.
02
Fill out your child's full name, date of birth, and grade
03
Specify the medication to be administered, including the name, dosage, and frequency
04
Indicate the reason for the medication and any specific instructions for administration
05
Sign and date the form, along with any required healthcare provider signatures
06
Return the completed form to the school nurse or designated school official
Who needs school administered medication authorization?
01
Any student who requires medication to be administered during school hours needs school administered medication authorization
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What is school administered medication authorization?
School administered medication authorization is a form that allows school personnel to administer medication to students during school hours.
Who is required to file school administered medication authorization?
Parents or guardians of the student are required to file school administered medication authorization.
How to fill out school administered medication authorization?
The form must be completed with details of the student, medication information, dosage, schedule, and any special instructions.
What is the purpose of school administered medication authorization?
The purpose is to ensure that students receive their required medication safely and effectively while at school.
What information must be reported on school administered medication authorization?
Information such as student's name, medication name, dosage, schedule, special instructions, and emergency contact information.
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