Medication Prescriber Parent Authorization - Colorado State 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by indicating whether your child needs to take prescription medication while at the program. Check 'Yes' or 'No' accordingly.
3. Fill in the participant’s name and the specific medication name that will be administered.
4. Provide the dosage information and any specific directions for taking the medication, such as whether it should be taken on an empty stomach.
5. Detail the time and frequency of administration, ensuring clarity for proper adherence.
6. List any relevant side effects and special storage requirements for the medication.
7. Indicate if the participant is capable of self-managed care by checking 'Yes' or 'No'.
8. Complete the prescribing physician's details, including their name, clinic name, telephone number, and fax/email address.
9. Finally, ensure a parent or guardian signs and dates the form to authorize self-medication.

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