FORM AAA-1075 CHESTERFIELD COUNTY PUBLIC SCHOOLS STUDENT-2026

1. Begin by clicking ‘Get Form’ to open the document in our editor.
2. In the first section, clearly print the student's name, date of birth, and the names of the physician or healthcare provider. Ensure accuracy as this information is crucial for medication administration.
3. Next, specify the name of the medication along with its expiration date. This ensures that only valid medications are administered.
4. Fill in the dosage, route, and time of administration at school. Be detailed to avoid any confusion during medication distribution.
5. Indicate the beginning and ending dates for medication administration. This helps school staff manage medication schedules effectively.
6. Complete the parent/guardian section by printing your name, signing, and providing your contact information. This confirms your request for medication administration.
7. If applicable, review and complete any additional sections regarding diabetes or asthma management as outlined in the form.

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