Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your designated editor.
2. Begin filling out the 'Student Name,' 'Date of Birth,' and 'Grade' sections at the top of the form. Ensure that this information is accurate and reflects the student’s records.
3. List any allergies the student may have in the designated area. This information is crucial for the healthcare provider and school personnel.
4. For the 'Medication Name' field, enter the name of the medication the student will be carrying. In the 'Route' section, specify how the medication is administered.
5. Detail the 'Reason for Administration' and provide the 'Exact Dose to be Given' in measurement units such as mg or puffs. This precision is necessary for safe medication administration.
6. Indicate the 'Time/Frequency of Administration.' If the medication is 'as needed' (prn), specify the frequency and the observable signs and symptoms that necessitate administration.
7. Clearly describe the 'Medical necessity to self-carry' in the appropriate section, stating why the student must carry the medication.
8. Fill in the 'Duration of Administration' required for the medication and list any relevant side effects. Be sure to indicate if there are none expected.
9. Have the healthcare provider sign and date the form. They must also print their name, provide a contact phone number, and a fax number.
10. The parent or legal guardian must read and acknowledge the authorization section, then sign and date the consent form. They should also provide their contact information.
11. Complete the 'Contract for Self Administration of Medication' section by providing the school name, grade, and authorization dates. Ensure all parties involved understand their responsibilities.
12. Finally, review all the entries to ensure completeness and accuracy, then save, download, and print the completed form as needed for submission to the school nurse.

Complete the MD Harford County Public Schools 1709142 form online today to ensure your student’s medical needs are met.