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ALABAMA STATE DEPARTMENT OF EDUCATIONSCHOOL MEDICATION PRESCRIBER/PARENT AUTHORIZATION School Year: ______STUDENT INFORMATION : ___ Date of Birth: ___/___/___Age: ___School: ___ Grade: ___ Teacher:
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It is a form that allows a student to receive medication at school, requiring authorization from both a licensed prescriber and a parent or guardian.
The parent or guardian of the student, along with a licensed prescriber, is required to file this authorization.
The form must be completed with the student's information, details about the medication, dosage, administration times, and signatures from both the prescriber and the parent.
Its purpose is to ensure that students who require medication during school hours can do so safely and in accordance with legal requirements.
Information such as the student's name, date of birth, medication name, dosage, frequency of administration, reason for medication, and emergency contact details must be reported.
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