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ST. CHARLES PARISH PUBLIC SCHOOL SYSTEM PARENT/GUARDIAN\'S REQUEST AND AUTHORIZATION FOR MEDICATION (Please Print) Student: ___ Grade:Teacher: ___M/F: ___DOB: ___School: ___Name of Medication: ___
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How to fill out medication order-parent form

01
Obtain a medication order-parent form from your healthcare provider or pharmacy.
02
Fill out the patient's information including name, date of birth, and any relevant medical conditions.
03
List the medications being requested, including the name, dosage, and frequency of each medication.
04
Provide any additional information requested, such as allergies or current medications being taken.
05
Sign and date the form to confirm that the information provided is accurate.
06
Submit the completed form to the healthcare provider or pharmacy for processing.

Who needs medication order-parent form?

01
Patients who require prescription medications from their healthcare provider.
02
Individuals who are responsible for managing medication for a family member or dependent.
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The medication order-parent form is a document used to request medication for a child under parental or guardian consent.
Parents or guardians of children requiring medication are required to file the medication order-parent form.
The medication order-parent form can be filled out by providing information about the child, medication details, dosage instructions, and parent/guardian signature.
The purpose of the medication order-parent form is to ensure proper authorization and administration of medication to children under parental or guardian supervision.
The medication order-parent form must include the child's name, medication details, dosage instructions, parent/guardian contact information, and signature.
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