Get Chesapeake Public Schools Medication Form

Filling out the Chesapeake Public Schools Medication Form online is an essential step in ensuring that students have access to their necessary medications during school hours. This guide provides clear and supportive instructions for each section of the form to assist you in completing it accurately.

Follow the steps to complete the medication form online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the student in the designated field. Ensure to include their last name, first name, and middle initial for clarity.
3. Next, provide the date of birth of the student. This information is crucial for verifying the identity and age of the student requiring medication.
4. Fill in the diagnosis field, detailing the medical condition for which the medication is required. This helps school staff to understand the context of the medication.
5. Input the prescribed dosage of the medication in the corresponding section, ensuring it matches the prescription provided by the healthcare provider.
6. Provide the home phone number and the parent or legal guardian's work phone number. This ensures that the school can reach you in case of any questions or emergencies.
7. Specify the medication name clearly in the designated field to avoid any confusion regarding what is being administered.
8. Indicate when the inhaler should be used. This is important for the timing of medication administration throughout the school day.
9. Outline the frequency with which the medication should be administered. This ensures that school staff are aware of how often to provide the medication.
10. Fill in the route of administration and any necessary instructions regarding how the medication should be taken.
11. Enter the start date for medication administration, remembering that this must be renewed yearly.
12. Complete the end date for medication, particularly if it is prescribed for a specific duration.
13. Have the physician or nurse practitioner print their name in the provided field, followed by their address and phone number. This verifies the source of the prescription.
14. Ensure the physician or nurse practitioner signs and dates the form to confirm the accuracy of the information provided.
15. Obtain the signature of the parent or legal guardian, ensuring they fully agree to the terms outlined and understand the implications of self-administration.
16. Lastly, save your changes, then download, print, or share the completed form as required.

Complete the Chesapeake Public Schools Medication Form online today to ensure your student receives their medication efficiently.