Common Contracts
1 similar Administration of Medication Agreement contracts
ContractAdministration of Medication Agreement • March 30th, 2016
Los Alamos Public Schools “We prepare confident, life-long learners.” Administration of Medication at SchoolAgreement for Diabetes Self-Assessment and Self-Administration of Medication Date: School: Student ID Number Last First MI Birth Date / / Gender Male Female Grade: Home Room Teacher Drug Allergies Parent/Guardian: Last First Relationship Home Phone # Cell Phone # Work Phone # My child’s physician, , has prescribed diabeticmedication, provided instruction to my child in the correct and responsible use of the medication, and approved my child’s ability to perform self-assessment and medication self- administration of the appropriate medication. The physician’s medical orders and treatment plan are currently on file in the school nurse’s office.I give permission for my child, , to self managehis/her diabetes as noted in the physician’s medical orders and his/her school health planMy child has been instructed in the self-assessment of his/her diabetes needs and has demonstrated th
