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East Peoria Elementary District 867:270E1Students
Exhibit School Medication Authorization Form
To be completed by the children parent(s)/guardian(s). A new form must be completed every school
year.
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How to fill out over-form-counter and prescription medications

How to fill out over-form-counter and prescription medications
01
Gather all necessary information such as name, address, date of birth, and contact information.
02
Obtain a prescription from a licensed healthcare provider for prescription medications.
03
Fill out the over-the-counter section with the desired medications, quantities, and any specific instructions.
04
Provide any insurance information or payment method required.
05
Review the form for accuracy and completeness before submitting it to the pharmacy.
Who needs over-form-counter and prescription medications?
01
Individuals with a valid prescription from a healthcare provider.
02
Patients seeking over-the-counter medications for self-treatment of minor ailments.
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What is over-form-counter and prescription medications?
Over-the-counter (OTC) medications are drugs available without a prescription, usually for common ailments. Prescription medications require a doctor's approval and are used for more serious health issues.
Who is required to file over-form-counter and prescription medications?
Healthcare providers, pharmacies, and manufacturers may be required to file records of over-the-counter and prescription medications used or dispensed.
How to fill out over-form-counter and prescription medications?
Filling out records for OTC and prescription medications typically involves providing details like the medication name, dosage, quantity, patient information, prescriber's details (for prescriptions), and date of dispensing.
What is the purpose of over-form-counter and prescription medications?
The purpose is to ensure safe and effective medication usage, monitor drug distribution, and prevent misuse or abuse of medications.
What information must be reported on over-form-counter and prescription medications?
Essential information includes the drug name, strength, form, quantity dispensed, prescribing physician's details, patient identification, and the date of transaction.
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