Medication Authority Pform
ID:0 | 23/09/2017 |
Recipient: Guest
Originator: Guest
School Logo
* Mandatory fields | 
1
Guest Info

Full Name *

Email Address *
2
INFORMATION

Student information and medication details


To be completed by the PARENT/GUARDIAN and/or ADULT STUDENT/CLIENT.

This information is confidential and will be available only to teaching/ support staff and emergency medical personnel.

Student's full name: *


Name of medication (include generic name): *

Form of medication  *

Route: *

Strength: *

Dose *

Please select administration time/s *








Specify time:

If your child requires tablets, how many tablets are you providing to the school?

Dates to be administered from: *

to: *

Please attach any other instructions for administration of medication. This includes whether information about whether the student’s condition creates any difficulties with self-management; for example, difficulty remembering to take medication at a specified time or difficulties coordinating equipment (e.g. puffer and spacer).

This plan has been developed for the school settings: *

AUTHORISATION AND RELEASE - Medical/Health Professional

Please state who is the authorised prescriber of the medication, their role and contact details.


Please note:

  • Schedule medication outside care/school hours wherever possible
  • Be specific: As needed is not sufficient direction for staff members—they need to know exactly when medication is required
  • Nominate the simplest method. For example: Oral or ‘puffer’ medication is much easier to arrange than a nebuliser
  • Young children (e.g. junior primary age) are supervised when they take their oral/puffer medication
  • Wherever possible, safe self-management is encouraged.

Hunter Christian School:

  • Accept only medication which has been ordered by a doctor and is provided in the original, fully labelled pharmacy container
  • Do not monitor the effects of medication as staff have no training to do this
  • Are instructed to seek emergency medical assistance if concerned about a person’s behaviour following medication
  • Do not administer panadol or over the counter medication


I have read, understood and agreed with this plan and any attachments indicated above. I approve the release of this information to supervising staff and emergency medical personnel. *


Enter the verification text below * :
 

eForms Workflow statistics  
   Refresh
Please select the student associated with this eForm from the list
  Next
Do you want to continue the partially filled eForm from the last session?



Warning: Saving New eForm will destroy any partially filled old eForm!