Get Asthma Medication Administration Form

The Asthma Medication Administration Form is an essential document for managing asthma in school settings. This guide provides clear, step-by-step instructions on how to complete the form online effectively.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the student's last name, first name, and middle initial in the designated fields.
3. Select the student's gender by marking the appropriate box for either 'Male' or 'Female.'
4. Fill in the date of birth using the required format: MM/DD/YYYY.
5. Attach a recent photo of the student to the document according to the instructions provided.
6. Input the OSIS number, DOE district, school name, and borough details.
7. Indicate the student's grade level in the appropriate field.
8. Have the student's health care practitioner complete the necessary diagnosis, control, and severity fields.
9. Complete the student asthma risk assessment questionnaire by selecting 'Yes' (Y), 'No' (N), or 'Unknown' (U) where applicable.
10. Select the type of quick relief in-school medication and provide details about its dosage and administration.
11. Fill out the in-school instructions based on practitioner recommendations, including any special instructions.
12. Complete the section regarding home medications, specifying whether the student is nurse-dependent, supervised, or independent.
13. The health care practitioner must provide their information, including name, signature, date, and contact details.
14. Both the parent/guardian and health care practitioner must sign at the required sections to authorize medication administration.
15. Finally, review the completed form, save changes, download a copy, print it, or share it as necessary.

Complete the Asthma Medication Administration Form online to ensure the best care for students with asthma.