Get Medication Order Form #410 - Federal Way Public Schools - Schools Fwps

Filling out the Medication Order Form #410 is crucial for ensuring that students receive the necessary medication during school hours. This guide will help you navigate the online form, providing clear steps on how to complete each section thoroughly and accurately.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the student's name, date of birth, school, grade, and student ID in the designated fields.
3. The licensed health care provider section requires completion. Input the name of the medication, diagnosis, dosage, route, and the time it should be administered.
4. Provide specific instructions and side effects that may be expected from the medication, ensuring clarity for school staff.
5. Indicate if the medication is to be given ‘as needed’ and specify the time interval between doses, if applicable.
6. Detail the emergency procedures in case of serious side effects, ensuring that this information is readily available to staff.
7. Confirm that the health care provider/designee has instructed the student on the correct use of the medication, and whether the student can self-administer the medication.
8. The health care provider must sign and print their name, along with providing the date, phone number, and fax number.
9. Next, the parent or guardian section needs completion. Please print the details, including the school, grade, birth date, student's name, and parent's or guardian's name.
10. Provide contact information for both the parent's work/cell phone and an emergency contact.
11. Check the appropriate boxes indicating consent for medication administration and information exchange between the school and health care provider.
12. If applicable, sign the Agreement of Exemption for self-carry/self-administration of life-saving medication, ensuring that all required notifications are completed.
13. If the student is 18 or older, they may sign on their own behalf, confirming their consent for communication between the school and health care provider.
14. Finally, review all entries for accuracy, save your changes, and at your discretion, download, print, or share the completed form.

Complete the Medication Order Form #410 online today to ensure your student's health needs are met at school.