DoDEA Form 08 SHSM H-3-9 Student Retention of Medication 2025

1. Click ‘Get Form’ to open it in the editor.
2. In Section 1, enter the student's name, date of birth, and grade. Provide details about the diagnosis, duration of treatment, medication name, dosage, route of administration, possible side effects, and specific times for medication administration.
3. Indicate whether a backup medication should be kept in the school health office by circling YES or NO. Describe what actions to take if expected results are not achieved or if there is an adverse reaction.
4. Ensure that the primary care manager/provider signs and stamps this section along with their contact information and date.
5. In Section 2, have the sponsor/parent/guardian read the physician’s statement and provide their signature and date to consent for the student to retain possession of their medication.
6. Section 3 must be completed by the student. They should sign and date after acknowledging their responsibilities regarding medication use.
7. Finally, ensure that the school nurse reviews these instructions with the student and provides their signature.

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