Get the free Emergency Medication Self-carry Agreement

This document outlines the process for students to selfadminister emergency rescue medication while at school, requiring agreements from parents, physicians, and the school nurse.

How to fill out emergency medication self-carry agreement

How to fill out emergency medication self-carry agreement

1. Obtain the emergency medication self-carry agreement form from your school or institution.
2. Read the instructions carefully before filling out the form.
3. Provide your personal information, including your name, date of birth, and contact details.
4. Specify the emergency medication that you will be carrying (e.g., EpiPen, inhaler).
5. Include the dosage and frequency of use for the emergency medication.
6. Fill out any required health information, such as allergies or existing medical conditions.
7. Obtain a signature from your parent or guardian, indicating their consent for you to carry the medication.
8. Sign the form yourself, agreeing to adhere to the guidelines for carrying and using the medication.
9. Submit the completed form to the appropriate school or health official for approval.

Who needs emergency medication self-carry agreement?

1. Students with specific medical conditions that require immediate access to emergency medication.
2. Individuals who are at risk of severe allergic reactions.
3. Patients with asthma or other respiratory conditions that may require rescue inhalers.
4. Anyone who has been prescribed emergency medication for life-threatening situations.

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What is emergency medication self-carry agreement?

An emergency medication self-carry agreement is a formal document that allows students or individuals to carry and administer their own emergency medication, such as inhalers or epinephrine auto-injectors, in case of a medical emergency.

Who is required to file emergency medication self-carry agreement?

Students who require emergency medication for conditions such as asthma or severe allergies are typically required to file an emergency medication self-carry agreement with their school or institution.

How to fill out emergency medication self-carry agreement?

To fill out an emergency medication self-carry agreement, individuals must provide personal information such as their name, details of the medication, instructions for use, and a signature from a parent or guardian, as well as a healthcare provider if required.

What is the purpose of emergency medication self-carry agreement?

The purpose of the emergency medication self-carry agreement is to ensure that individuals have access to necessary medications during emergencies while maintaining safety and compliance with school or organizational policies.

What information must be reported on emergency medication self-carry agreement?

The emergency medication self-carry agreement must report the individual's personal information, specifics about the medication (e.g., name, dosage), the conditions requiring the medication, and emergency contact details.