Wpanc authorizationformedicationtobeWayne Preparatory Academy School Health Form AUTHORIZATION 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name and date of birth in the designated fields at the top of the form.
3. Fill in the school, teacher, and grade information to ensure proper identification of your child.
4. In the section for physician or authorized prescriber, input the name of the medication along with its purpose if desired.
5. Select the form of medication from options such as tablet, liquid, inhaler, etc., and specify dosage and timing for administration at school.
6. Indicate any restrictions or side effects that may occur and provide special storage requirements if necessary.
7. Have the physician complete their information including name, address, phone number, and signature. Ensure they stamp the form as required.
8. As a parent/guardian, sign and date where indicated to authorize medication administration at school.
9. Finally, submit this completed form to your school office for processing.

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