Prescription medication - Chesterfield County Public Schools 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name, date of birth, grade, school, and student ID number in the designated fields. Ensure all information is accurate and clearly printed.
3. In the parent/guardian section, print your name and provide your signature along with the date and phone number. This confirms your request for medication administration.
4. For the healthcare provider section, ensure that a licensed professional fills out the medication details including dosage, reason for medication, possible side effects, and any special handling instructions.
5. Review all entries for accuracy before saving or printing the completed form. Make sure to keep a copy for your records.

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