Self administer medication form
HSP154 Carying and or self administration of medication
The following form must be completed for all children and young people where the parent/guardian has requested they carry their own medication and/or self-administer their own medication. This form is developed in partnership and has co-ownership with the South Australian
[DOCX File]AUTHORIZATION TO CARRY AND SELF ADMINISTER
https://info.5y1.org/self-administer-medication-form_1_e2a1c2.html
AUTHORIZATION TO CARRY AND SELF ADMINISTER. RESPIRATORY MEDICATION OR EPINEPHRINE AUTO-INJECTOR. This form must be completed so that we may provide the best care for your child. Please return this form to the school health office so that your child may have permission to carry and self-administer their: Respiratory medication . Epinephrine auto ...
[DOC File]INDEPENDENT WITH MEDICATION SELF-ADMINISTRATION
https://info.5y1.org/self-administer-medication-form_1_0e8832.html
SELF-ADMINISTRATION OF MEDICATIONS. Able to self-administer accurately? ( Yes ( No. Understands medication use(s)? ( Yes ( No. Medications taken at the correct time at the right dose? ( Yes ( No. After evaluation, resident is ( able ( not able to safely self-administer medications.
AUTHORIZATION FOR SELF-CARRY/ADMINISTRATION OF …
In my professional opinion, this student is competent in the self-administration of this medication, if needed, and is capable of carrying this medication. _____ _____ _____ Physician Signature Telephone Date. PARENT/GUARDIAN AUTHORIZATION. I request that my child, named above, be permitted to carry and self-administer the above ordered medication.
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