Follow the steps to complete your Student Medication Administration Request online.

1. Click the ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering the name of the student. Provide the student's last name, first name, and middle initial as requested.
3. Next, indicate the student's date of birth in the designated field.
4. List the name of the physician, physician’s assistant, or nurse practitioner who prescribed the medication.
5. Enter the name of the medication being administered, along with the expiration date of that medication.
6. Specify the dosage, route, and time of administration at school in the relevant section.
7. Indicate the beginning and ending dates for the administration of this medication.
8. In the next section, provide your name as the parent or guardian. Print your name clearly.
9. Affix your signature in the designated area, confirming your request for the medication to be administered to your child.
10. Date your request and provide a phone number where you can be reached.
11. If applicable, provide permission for your child to self-administer medications such as auto-injectable epinephrine or inhaled asthma medications, making sure to address the necessary conditions outlined.
12. Finally, review all the information for accuracy, then save your changes. You may choose to download, print, or share the completed form as needed.

Complete your VA Chesterfield County Public Schools AAA-1075 form online today to ensure your child's medication needs are met.