Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to access the form and open it in your online editor.
2. Begin by entering the name of the student in the designated field and provide their date of birth (DOB) and grade.
3. In the section for medication details, fill in the diagnosis and the indication for medication administration.
4. Continue by specifying the medication name, dosage, time, route of administration, and the duration for which the medication will be taken.
5. List any possible side effects and any precautions or restrictions as advised by the physician.
6. Obtain the signature and stamp from the Physician/Primary Care Manager (PCM), and include their clinic phone number.
7. In the section for the parent/guardian, provide the name of the student who is authorized to receive the medication and include your signature along with the date.
8. Finally, a school nurse will complete the last section by entering the date medication is received, amount received, expiration date, and adding any nurse's notes required.
9. Once all fields are completed, make sure to save the changes, and you can choose to download, print, or share the completed form.

Complete the necessary documents online to ensure your child's health and safety at school.