Form online 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the school name and teacher's name in the designated fields at the top of the form.
3. Fill in the student's name, grade, date of birth, and any known allergies to ensure accurate medication administration.
4. In the medication section, specify the medication name, dosage, scheduled time, and route of administration.
5. Document physician details including their name and phone number for reference.
6. For each medication count entry, provide signatures for both the person counting and a witness. Include details such as pill description and counts.
7. Complete sections regarding parent/guardian contact dates for medicine pickup or destruction, ensuring all signatures are collected where required.

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