Get 5330 F4apage 1 Of 1

Filling out the 5330 F4a form is a straightforward process that ensures your child's asthma medication needs are met during school hours. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the 5330 F4a form online.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Enter the student's name in the designated field for 'Student Name'.
3. Fill in the student's birth date in the 'Birth Date' section. Ensure the format is clear and consistent.
4. Provide the student's address in the 'Address' field to ensure proper identification.
5. Input a contact number in the 'Phone Number' section where you can be reached during school hours.
6. Designate an emergency contact person along with their details to be reached if necessary.
7. Specify the student’s asthma condition in the provided space for clarity.
8. List the name of the medication prescribed, as well as its type (tablet, liquid, or capsule) in the corresponding fields.
9. State the purpose of the medication and the dosage required, detailing the time(s) it should be administered.
10. Outline any special circumstances under which the medication should be given to the student.
11. Mention possible side effects that may occur due to the medication.
12. Certify that the student has been instructed in the self-administration of the medication, including obtaining the prescriber's signature and print name.
13. Complete the date of signing and include the prescriber's emergency phone number and address for verification.
14. Once you have filled out all sections, review the information for accuracy. You can then save changes, download, print, or share the completed form as needed.

Complete and submit your documents online to ensure your child's health needs are managed effectively.