Get Licensed Medical Provider Order Form - Dcs.k12.oh.us

Filling out the Licensed Medical Provider Order Form online is a vital step toward ensuring that students receive the necessary health care services while at school. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete the Licensed Medical Provider Order Form online.

1. Use the ‘Get Form’ button to access the Licensed Medical Provider Order Form and open it in the appropriate editing tool.
2. Fill in the student's name and birth date at the top of the form.
3. In section I, describe the condition that necessitates the required procedure clearly and concisely.
4. In section II, detail the procedure(s) to be performed, ensuring that all relevant information is included.
5. For section III, indicate the time schedule for the procedure, specifying the date until which the procedure should be continued.
6. In section IV, outline any precautions, possible adverse reactions, or interventions that should be noted.
7. For section V, specify any special equipment required for the procedure.
8. In section VI, describe any physical limitations the student may have.
9. Proceed to section VII to list any special dietary requirements essential for the student's health.
10. In section VIII, provide detailed information about medications prescribed, including the dose and expected side effects.
11. In section IX, the parent or guardian must sign and date the authorization request for health care procedures.
12. In section X, the licensed medical provider should verify the procedures and treatments, sign, and date the form.
13. Complete any additional authorizations needed for the exchange of medical information if applicable.
14. Once all sections are filled out, save changes, and proceed to download, print, or share the form as needed.

Complete your Licensed Medical Provider Order Form online today to ensure timely health support for your student.