PART I TO BE COMPLETED BY THE PARENT/GUARDIAN I hereby request and authorize Montgomery County Public Schools (MCPS) and Montgomery County Department of Health and Human Services (DHHS) personnel to administer prescribed medication as directed by an authorized prescriber (Part II below). I agree to release, indemnify, and hold harmless MCPS and DHHS and any of their officers, staff members, or agents from lawsuit, claim, demand, or action against them for administering prescribed medication to.
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the MD MCPS 525-13 online
Filling out the MD MCPS 525-13 form is essential for ensuring that prescribed medication is administered properly within Montgomery County Public Schools. This guide provides a clear, step-by-step approach for completing the form online, making the process straightforward and accessible for all users.
Follow the steps to complete the MD MCPS 525-13 form effectively.
- Click the ‘Get Form’ button to access the MD MCPS 525-13 form online in the designated editing tool.
- In Part I, fill in the student's name and birthdate. Indicate whether the prescription is a renewal or a new prescription, and provide the school name by selecting from the dropdown menu.
- If the prescription is new, input the date when the first full dosage was given at home. Next, list all medications the student is currently taking, including any over-the-counter medications.
- Sign in the Parent/Guardian Signature section, including the date and provide a contact phone number.
- Proceed to Part II, where the authorized prescriber must enter the name and dosage of the medication. Ensure to specify the diagnosis, time(s) to be administered at school, and the route of administration.
- Input the effective dates for when the medication is to be administered. Note any potential side effects, especially if the medication is to be given on an as-needed (PRN) basis, and specify the conditions under which it should be administered.
- Have the authorized prescriber print/type their name, sign, and provide their phone number and the date.
- In Part III, the principal or school nurse must check appropriate boxes to confirm all required information from Parts I and II are completed accurately. Make sure the medication is labeled correctly.
- Finally, have the Principal/School Nurse sign and date the form before submission.
- After completing the form, you can save your changes, download a copy, print it for your records, or share it as needed.
Complete the MD MCPS 525-13 form online today to ensure proper administration of medication at your child’s school.
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
School Health and MCPS follow State of Maryland vaccine requirements for ... child during...
Maryland Schools Record of Physical Examination ... including over the counter medication...
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.
This form is available in several versions. Select the version you need from the drop-down list below.