Health Forms
Medication Order to be Completed by a Licensed Prescriber:
| md_order.pdf |
Parent/Guardian Authorization for Medication Administration:
| parent_authorization_word_doc.pdf |
Emergency Health Care Plan with Physician's Orders (also referred to as the Epi pen HCP front and back):
| epi_pen_hcp_front_and_back_blank_year.pdf |
When filling out these forms, please keep the following in mind:
- I need one medication order PER CHILD PER FORM. You cannot put multiple children on a medication order from the physician.
- When filling out the parent authorization to administer medication form, please fill out one form per child; however, you can list all of the medications you are authorizing on that one form.
- Physicians, physician assistants, and nurse practitioners are all considered licensed prescribers; hence, they are the only ones authorized to sign a medical order. Registered nurses cannot sign their name to medical orders, as it will not be valid.
