Get Ade09-da17 Annexe 1 Form A Franais Au Verso

Filling out the ADE09-DA17 Annexe 1 FORM A is a crucial step in the administration of prescribed medication and medical procedures in a school setting. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete the ADE09-DA17 Annexe 1 FORM A online.

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Enter the student's name in the designated field. Ensure that the spelling is accurate as this identifies the individual for whom the medication is prescribed.
3. Provide the student's date of birth. Use the format specified in the form, ensuring clarity in identification.
4. Fill in the address of the student. This should be the home address where the student resides.
5. Input the telephone number of the parent or guardian. Ensure this number is reachable and correct.
6. Record the name of the school where the student is enrolled. This helps in directing the information to the right institution.
7. Indicate the student’s grade level. This is important for school records and planning.
8. Write down the teacher’s name responsible for the student. If there are multiple teachers, specify the primary contact.
9. In the physician’s statement section, detail the necessary medication, including both generic and trade names.
10. Specify the dose of the medication required (e.g., milligrams or volume) in the next section.
11. Indicate the method of administration, such as oral or inhaled.
12. Provide the dosing interval in the corresponding field to indicate when the medication should be given.
13. Clarify the length of treatment required, whether it’s for one week, one month, or continuously.
14. State whether there are any anticipated untoward reactions by indicating Yes or No and detailing any potential symptoms.
15. If there are special instructions related to the medication, indicate Yes or No and list those instructions in the provided area.
16. Describe the medication thoroughly, including form (pills or liquid) and any distinguishing features like color.
17. Specify the maximum quantity of medication that can be kept at the school in the relevant field.
18. Indicate how long the medication can be stored, ensuring to include an expiration date if applicable.
19. If there are any additional special instructions concerning storage or administration, document them as necessary.
20. Obtain the physician’s signature, and ensure they provide their address and telephone number. The date of signing must also be included.
21. Once all fields are completed accurately, save the changes. You can then download, print, or share the form as needed.

Start filling out your documents online today for a streamlined process.