Get Medication Request Form - Unified School District Of Antigo

The Medication Request Form is a vital document for ensuring that students receive necessary medications while attending school. This guide will walk you through the process of filling out the form accurately and efficiently, helping to facilitate your child's medication needs in an educational environment.

Follow the steps to complete the Medication Request Form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the student’s name, date of birth, grade, teacher, and school year in the designated fields.
3. Indicate the name of the medication and the reason for administering it.
4. Select the form of medication by circling either 'Tablet or Capsule', 'Inhaler', or 'Other' and specify if needed.
5. Fill in the dose by circling 'once daily' with the time or 'once every ___ hours as needed'.
6. Provide the start date for when the medication should begin and the date the medication was received at school.
7. Choose the end date for the medication administration by circling either 'End of school year' or specifying another date.
8. Specify where the medication will be kept by circling 'School Office' or 'Other' and providing details if needed.
9. Indicate whether the student will need staff assistance with medication by circling 'Yes' or 'No'.
10. Add any comments regarding possible side effects in the comments field.
11. Enter the health care provider's name, phone number, and fax number in the appropriate fields.
12. Obtain the health care provider's signature and the date of signature, when applicable.
13. Check the box for health care provider authorization and have the parent or guardian sign and date the form.
14. Review all entries for accuracy and completeness, then save changes, download, print, or share the form as needed.

Complete the Medication Request Form online to ensure your child's medication needs are met at school.