Get Request For Provision Of Medically Prescribed Treatment (non ... - Schools Nyc

This guide provides clear and detailed instructions on how to accurately complete the Request for Provision of Medically Prescribed Treatment form for students requiring specific medical treatments in New York City schools. By following these steps, you can ensure that all necessary information is submitted properly to facilitate your child's medical care at school.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the Request for Provision of Medically Prescribed Treatment (non-medication) form and open it in the appropriate editor.
2. Provide the student's last name, first name, and middle name in the corresponding fields, along with the date of birth and the OSIS number.
3. Fill in the details of the school, including its name, number, address, and borough. Indicate the grade and class as well.
4. Complete Part I: Physician's Statement/Order by specifying the medical treatments needed. You can select options such as clean intermittent catheterization or tracheostomy care and specify the details related to each treatment.
5. Enter the diagnosis, including related ICD codes and conditions. This information is vital for understanding your child's medical needs.
6. Detail the required treatment in school and provide specifics, including the type of feeding if applicable, duration, and any other essential instructions.
7. Outline the frequency and specific times the treatments should be administered during school hours.
8. Indicate any conditions under which the treatment should not be provided.
9. Fill in the dates for when the treatment should be initiated and terminated.
10. List possible side effects or adverse reactions that could occur from the treatment.
11. Make sure to fill out the healthcare practitioner's information, including full name, contact number, and license details.
12. The parent or guardian must sign and date the consent and authorization section to confirm their understanding and agreement.
13. Finally, save your changes, download, print, or share the completed form as needed to submit it to the school.

Complete your documents online to ensure timely and accurate provision of medically prescribed treatment for your child.