Edit, Download, and Sign the Request for Medication Administration Form
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How do I fill this out?
To fill out this form, start by entering the student's information, including their name and school. Next, provide the medication details along with the prescribed dosage and administration instructions. Finally, a parent or legal guardian must sign the form to grant permission.
How to fill out the Request for Medication Administration Form?
1
Complete the student information section.
2
Fill in the medication details including diagnosis and dosage.
3
Indicate the time and route of administration.
4
Obtain a signature from the parent or legal guardian.
5
Submit the form according to school guidelines.
Who needs the Request for Medication Administration Form?
1
Parents who need to provide medication to their child during school hours.
2
School nurses requiring documentation for medication administration.
3
Healthcare providers prescribing medication for school-aged children.
4
Guardians who manage medication for children with health conditions.
5
Administrators needing to maintain compliance with health policies.
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Edit your Request for Medication Administration Form online.
Edit this PDF using our PrintFriendly tool by clicking on the edit button. Make changes directly to the text fields to reflect accurate medication information. Save your edits before downloading the revised document.
Add your legally-binding signature.
You can easily sign the PDF on PrintFriendly by using the signature field provided. Fill in your name and date to authorize the medication administration. Your signature ensures that the school has permission to administer the medication as prescribed.
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How do I edit the Request for Medication Administration Form online?
Edit this PDF using our PrintFriendly tool by clicking on the edit button. Make changes directly to the text fields to reflect accurate medication information. Save your edits before downloading the revised document.
1
Open the PDF in the PrintFriendly editor.
2
Select the text fields to edit them directly.
3
Make necessary changes regarding medication information.
4
Review your edits for accuracy.
5
Download the edited PDF or share it as needed.
What are the instructions for submitting this form?
Submit the completed Medication Administration Form to your child's school office by fax or in-person. Ensure that the guardian's signature is included for authorization. If submitting by fax, use the number provided on the school's contact page, or deliver the form to the school secretary directly.
What are the important dates for this form in 2024 and 2025?
Important dates for the submission and renewal of medication forms will typically follow the school year schedule. Parents should check with their child's school for specific deadlines each year. For 2024 and 2025, forms must be submitted at the beginning of the school year and renewed as needed.
What is the purpose of this form?
The purpose of this form is to ensure safe and accurate administration of medications to students during school hours. It provides necessary information for school health staff to manage a child's specific medical needs effectively. Additionally, it establishes clear communication between parents, healthcare providers, and school administration regarding a child's medication requirements.
Tell me about this form and its components and fields line-by-line.
- 1. Today's Date: The date the form is being filled out.
- 2. Name of Student: Full name of the student needing medication.
- 3. School Student Attends: The name of the school the student is enrolled.
- 4. Student's Diagnosis: The medical diagnosis requiring medication.
- 5. Medication: Name of the medication prescribed.
- 6. Dosage: Amount of medication to be administered.
- 7. Time of Administration: When the medication is to be given.
- 8. Route of Administration: How the medication is to be administered.
- 9. Instructions: Additional notes or special instructions regarding administration.
- 10. Start Date: When the administration of the medication begins.
- 11. End Date: When the administration of the medication ends.
- 12. ICD-9 Code: The diagnostic code for Norfolk Public Schools.
- 13. Physician/Nurse Practitioner/Dentist's Name: Name of the medical professional prescribing the medication.
- 14. Student's Date of Birth: The student's date of birth.
- 15. Phone Number: Contact number for the prescribing physician.
- 16. Physician Signature: Signature of the prescribing physician.
- 17. Parent/Guardian Signature: Signature of the parent or legal guardian granting permission.
- 18. Home Phone Number: Parent or guardian's home contact number.
- 19. Work Phone Number: Parent or guardian's work contact number.
What happens if I fail to submit this form?
Failure to submit this form may result in the inability to administer necessary medication during school hours. This can potentially jeopardize a student's health and well-being. It's important for parents to ensure timely submission to avoid any issues.
- Health Risks: Students may not receive vital medications, leading to health crises.
- Non-Compliance with School Policies: Schools require this documentation to comply with health regulations.
- Lack of Communication: Failure to communicate medication needs can affect student care.
How do I know when to use this form?
- 1. Routine Medications: For students who need daily medication such as asthma inhalers.
- 2. Long-Term Medications: For chronic conditions requiring ongoing medication management.
- 3. Post-Surgery Medications: For students recovering from medical procedures needing medication at school.
Frequently Asked Question
How do I access the Medication Administration Form?
You can access the form directly from the PrintFriendly website.
Can I edit the PDF after downloading it?
No, edits must be made on the PrintFriendly platform before downloading.
How do I submit the completed form?
Submit the form by fax or in person to the appropriate school office.
Are there specific medication guidelines?
Yes, the form includes guidelines for prescribing and administering medication.
Do I need to submit a new form for each medication change?
Yes, any changes require a new written order from the prescribing physician.
What if I forget to send the form?
If the form is not submitted, the school cannot administer the medication.
Can my child carry their medication?
Students are generally not allowed to transport medication unless authorized.
Is this form accepted by all Hampton Roads Schools?
Yes, it's accepted by all public schools in the Hampton Roads area.
What information do I need to fill in?
You must provide student details, medication info, and guardian's authorization.
Is there an expiration date for the form?
The form should specify the start and end date for medication administration.
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