Get Epinephrine Administration Form - District 158 - District158

Filling out the Epinephrine Administration Form is essential for the safety and health of students who require specific medication during school hours. This guide provides clear and concise steps to assist you in completing the form accurately and efficiently online.

Follow the steps to successfully fill out the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the student’s name, grade, and school in the designated fields. Make sure this information matches the records at the school.
3. Input the student's address details including city and zip code to ensure proper identification and location.
4. Fill in the name of the parent or guardian along with their home and emergency phone numbers. This is crucial for contact purposes in case of emergency.
5. The student's physician must complete the medical section. Provide the physician's name, type of epinephrine, dosage, and diagnosis requiring medication. Be precise and ensure all details are legible.
6. Indicate when to administer epinephrine and/or Benadryl. Include specific circumstances or symptoms that would warrant the administration.
7. If the medication is to be carried by the child, have the physician confirm the student’s understanding of self-administration and the importance of reporting side effects.
8. The physician must sign and date the form. Additionally, the physician's name, address, office phone number, and emergency phone number should be provided.
9. As a parent or guardian, review the consent statement and sign and date the form to authorize the administration of the medication.
10. Once all fields are completed, save changes, then choose to download, print, or share the completed form as necessary.

Take the next step towards ensuring your child's safety by completing the Epinephrine Administration Form online today.