Get Philadelphia Public School Authorization Administer Medication Form

The Philadelphia Public School Authorization Administer Medication Form is essential for ensuring that students receive necessary medications and treatments during school hours. This guide provides detailed steps for filling out the form online, ensuring clarity and support for all users.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in the name of the patient or student, followed by their date of birth. This information is essential for identifying the individual receiving medication.
3. Provide the address and zip code of the student. Include the school or organization number, room or book number, regional office, and PID if available.
4. Document the diagnosis and the reason why medication or treatment must be administered in school.
5. Authorize selected school personnel to administer the indicated medication or use prescribed equipment by signing in the designated area.
6. List the medication, equipment, or treatment required in the section provided. Ensure to specify the dosage, frequency and total dosage per 24 hours.
7. Indicate the start and end dates for the medication or treatment.
8. Provide clear instructions for the administration or utilization of the medication/equipment, as well as any contraindications.
9. Include the parent or guardian's signature along with their telephone number, date signed, and emergency number.
10. If applicable, assess if the student may self-administer medication. Indicate yes or no in the provided space.
11. Fill in any necessary action to be taken for side effects and describe restrictions on activity if required.
12. Have the school nurse review and sign the form. Include their contact details.
13. If a health care provider is involved, ensure their information and signature are provided in the appropriate sections.
14. After completing all sections, review the entire form for accuracy. Save any changes, and consider downloading or printing the form for your records.

Complete the Philadelphia Public School Authorization Administer Medication Form online to ensure your child receives the necessary medications and support.