Get Request For Administration Of Prescribed Medication - Huber Heights - Huberheightscityschools

This guide provides clear, step-by-step instructions for completing the Request For Administration Of Prescribed Medication for students in Huber Heights City Schools. By following these instructions, you can ensure that the necessary information is accurately communicated to facilitate medication administration at school.

Follow the steps to complete the form online effectively.

1. Click ‘Get Form’ button to access the document and open it in your editing tool.
2. In Part I, begin by entering the name of the student and their date of birth in the designated fields.
3. Provide the student's address and the name of the school building they attend, followed by the principal's name and the student's grade.
4. List the name of the medication that is to be administered, along with the specific dosage quantity and frequency of administration.
5. Indicate the start and end dates for the medication, and include any potential reactions that should be reported to the physician.
6. If there are special instructions for the administration of the medication, include those details in the provided space.
7. Complete the physician's name, address, phone number, and fax number, and ensure the physician signs and dates the form.
8. In Part II, the parent, foster parent, or guardian should read the agreement carefully. They must then sign and date at the specified fields, providing their contact information.
9. Complete Part III by listing the names of individuals authorized to administer the medication at school, and ensure a nurse or principal signs the form.
10. Once all sections are filled out, review the information for accuracy, then save your changes, and if necessary, download, print, or share the completed form as needed.

Take proactive steps to ensure your child’s health by completing the required document online today.