Get Il Harlem School District 122 Medication Authorization Form 2017-2026

Completing the IL Harlem School District 122 Medication Authorization Form online is a straightforward process that helps ensure your child's medical needs are met while at school. This guide provides clear and detailed instructions to assist you in filling out the form accurately and effectively.

Follow the steps to complete the medication authorization form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the student's name, birth date, address, home phone number, school name, emergency contact phone number, grade, and teacher in the designated fields.
3. In the section for the physician, dentist, or qualified medical professional, input their printed name, office address, office phone number, and emergency phone number.
4. Specify the medication being prescribed, including dosage, frequency of administration, and the time or situation in which the medication is to be given.
5. Fill in the prescription date, the order date, and the discontinuation date for the medication if applicable.
6. Indicate the diagnosis that necessitates the administration of the medication. Additionally, answer whether this medication must be administered during school hours to allow the child to attend school or manage a medical condition by selecting 'Yes' or 'No'.
7. List any expected side effects from the medication, along with other medications the student may be receiving.
8. The physician must sign and date the form to validate the information provided.
9. For parents or guardians who permit their child to self-administer asthma medication or other supplies, initial the section confirming their understanding of the related legal notice.
10. Finally, all parents and guardians must sign and date the bottom of the form, acknowledging their responsibility and allowing for contacting the physician if needed.
11. Once all fields are completed, you can save changes, download, print, or share the form as necessary.

Complete your forms online to ensure your child has the necessary medication support at school.