
5330 F1/page 1 of 3 PARENT REQUEST AND AUTHORIZATION TO ADMINISTER A PRESCRIBED MEDICATION/DRUG OR TREATMENT To the Parent THE FOLLOWING INFORMATION IS NECESSARY FOR ANY STUDENT TO USE PRESCRIBED MEDICATIONS OR TO RECEIVE TREATMENT IN SCHOOL. ALL SPACES MUST BE COMPLETED. NEOLA 2006 LICENSED PRESCRIBER S STATEMENT To the Prescriber The School District requires that all of the following information be provided before it will administer medication .
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How to fill out the Neola 5330 F1 Form online
The Neola 5330 F1 Form is essential for authorizing the administration of prescribed medications or treatments for students. Completing this form accurately ensures that your child receives the necessary care while at school, and it is vital that all sections are thoroughly filled out.
Follow the steps to complete the Neola 5330 F1 Form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling in the name of the student in the designated space. Ensure spelling is correct.
- Next, provide the home address of the student. This information is necessary for identification.
- Enter the name of the school where the student is enrolled to ensure proper coordination.
- Indicate the grade of the student so that the school staff can take appropriate measures.
- In Section A, check all applicable boxes to specify the permissions you are requesting, including medication use, treatment, or self-administration.
- In Section B, acknowledge that you will take responsibility for delivering the medication to the school.
- Section C requires you to agree to notify the school of any changes regarding medication or treatment.
- In Section D, read the release statement and consider the implications before signing.
- Sign and date the form as the parent or guardian, and provide your home and work telephone numbers for contact purposes.
- If applicable, the licensed prescriber’s statement must be filled out with the necessary medication details and prescription information.
- Once all sections are complete, review the form for accuracy, then save your changes, download, print, or share the completed form as needed.
Complete the Neola 5330 F1 Form online today to ensure your child's health needs are met in school.
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