Get Medication Administration Form

Filling out the Medication Administration Form is essential for ensuring that students receive the proper medical care during school hours. This guide provides a clear, step-by-step approach to assist users in completing the form accurately and effectively online.

Follow the steps to complete the Medication Administration Form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Start by filling in the student's personal details, including last name, first name, middle initial, and date of birth. Ensure the date is formatted as MM/DD/YYYY.
3. Select the student's gender by marking the appropriate checkbox for 'Male' or 'Female'. Provide the OSIS number, DOE district, grade, and class in the specified sections.
4. The next section is to be completed by the student's health care provider. Enter the diagnosis, including the ICD code for asthma, and select the asthma severity from the given options.
5. In the 'In School Asthma Medications' section, choose the rescue medications required, and specify if the student may carry and self-administer the medication. Initial the reverse side if applicable.
6. Fill out details for inhaled corticosteroids, including the medication name, and additional asthma medication if needed. Choose the student’s self-administration permissions where indicated.
7. Complete the 'Home Medications' section by listing any medications taken at home, including dosage and timing. Be sure to provide any special instructions as needed.
8. Have the health care provider print and sign their name, include their title and contact information, and provide their NYS license number and Medicaid number.
9. Obtain the parent/guardian's consent by ensuring they complete their signature, print name, date signed, and provide contact details as outlined in the form.
10. Review all completed sections for accuracy. Once satisfied, save changes, download a copy for your records, and share or print the document as needed.

Complete your Medication Administration Form online today to ensure your child's health needs are met at school.