Get Standard Medication Order Form - Springfield Central High School

Filling out the Standard Medication Order Form is essential for ensuring that students receive the medications they need during school hours. This guide will provide you with detailed, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete your medication order form online.

1. Click ‘Get Form’ button to access the Standard Medication Order Form and open it in the editor.
2. Begin by entering the student's personal information. Fill in the last name, first name, and date of birth in the designated fields.
3. Indicate the student's gender by selecting either 'M' or 'F'.
4. Complete the prescription information section. The ordering Physician or Nurse Practitioner must fill in their details, including the start and end dates for medication administration.
5. List the name of the medication in the appropriate field, followed by the medical diagnosis that necessitates its use. Additionally, indicate any allergies the student may have.
6. Provide the administration details: select the route of administration, dosage required, and specific times for medication administration or 'PRN' (as needed).
7. If PRN medications are applicable, specify the frequency of use, noting whether it may be repeated once or twice. Clearly outline specific instructions for PRN medications.
8. Document any potential side effects associated with the medication.
9. Indicate if the student is allowed to self-administer an inhaler or Epi-pen by circling 'YES' or 'NO'.
10. The prescribing Physician or Nurse Practitioner must print their name, sign the document, and apply their office stamp in the designated area.
11. A parent or guardian must provide their signature, confirming permission for assistance or self-medication during school hours. Enter the date of authorization.
12. Finally, input the parent or guardian's contact information, including home, cell, and emergency phone numbers.
13. The school nurse should sign and date the form after verifying the orders.
14. Once all sections are completed, save your changes to the form. You may download, print, or share the form as needed.

Ensure your child receives the necessary medications by completing the Standard Medication Order Form online today.