Official State Of Louisiana Medication Order Template in PDF Fill Out My Document Online

Official State Of Louisiana Medication Order Template in PDF

The State of Louisiana Medication Order form is a critical document designed to ensure that students receive the necessary medications during school hours. This form must be completed by a licensed prescriber and involves input from a parent or legal guardian, ensuring that the health and safety of the student are prioritized. It is essential for parents and guardians to fill out this form accurately to facilitate proper medication administration while their child is at school.

To begin the process of filling out the form, please click the button below.

Fill Out My Document Online
Structure

Document Overview

Fact Name Description
Governing Law The Louisiana Medication Order Form is governed by Louisiana Revised Statutes Title 17, Section 436.1.
Form Purpose This form is used to authorize the administration of medication to students during school hours.
Completion Requirement Both a parent or legal guardian and a licensed prescriber must complete different sections of the form.
Medication Administration Medications are typically administered by unlicensed personnel under supervision.
Separate Orders Each medication order must be written on a separate form, ensuring clarity and compliance.
Special Circumstances Any special circumstances for medication administration must be approved by the school nurse.
Self-Administration Students may carry certain medications, like inhalers, if they meet specific criteria for self-administration.
Changes in Orders Future changes in medication directions require new orders to be submitted to the school.

Check out Popular Templates

Louisiana Fd 9 - Testing laboratories must be certified to perform the required analyses on source water.

A Power of Attorney form is a legal document that authorizes one person to act on behalf of another in either specific or general legal matters. It's a powerful tool that can grant authority over financial, legal, or medical decisions. For those seeking reliable resources and information on this topic, visiting UsaLawDocs.com can be incredibly helpful. This makes understanding the form’s details and implications vital for anyone considering its use.

Louisiana Real Estate Commission Forms - It is important for both sellers and buyers to keep copies of all negotiations for reference.

Detailed Steps for Writing State Of Louisiana Medication Order

Completing the State of Louisiana Medication Order form is essential for ensuring that students receive their medications safely and effectively while at school. Follow these steps carefully to fill out the form correctly.

  1. Begin with Part 1. Fill in the student’s name, birthdate, school, and grade.
  2. Provide the name of the parent or legal guardian and have them sign the form. Include the date of signing.
  3. Note that a separate parental/legal guardian consent form is required. Obtain this from the school nurse.
  4. Move to Part 2. The licensed prescriber should complete this section.
  5. List the relevant diagnosis(es) for the student.
  6. Describe the student’s general health status.
  7. Specify the medication name and its strength.
  8. Indicate the dosage, route of administration (by mouth, inhalation, or other), frequency, and time of each dose.
  9. State the duration of the medication order, either until the end of the school term or another specified time.
  10. Explain the desired effect of the medication.
  11. List any possible side effects of the medication.
  12. Note any contraindications for administering the medication.
  13. Document any other medications the student is taking outside of school.
  14. Provide the date of the student’s next visit to the prescriber.
  15. Complete the prescriber’s name, address, phone, and fax numbers.
  16. Have the prescriber sign the form and include their credentials and date.
  17. For Part 3, if applicable, answer questions regarding self-administration of medication.
  18. Ensure the licensed provider signs and dates this section if it applies.

Once the form is completed, it should be submitted to the school nurse. Make sure to keep a copy for your records. Any future changes will require a new order form. If you have questions, reach out to the school nurse for assistance.

Form Preview

STATE OF LOUISIANA

MEDICATION ORDER

TO BE COMPLETED BY LA, TX, AR, OR MS LICENSED PRESCRIBER

(In most instances, medications will be administered by unlicensed personnel.)

PART 1: PARENT OR LEGAL GUARDIAN TO COMPLETE.

Student’s Name ______________________________________________ Birthdate _______________

School _____________________________________________________ Grade _________________

Parent or Legal Guardian Name (print): ________________________________________________

Parent or Legal Guardian Signature:______________________________________________ Date:__________

(Please note: A parental/legal guardian consent form must also be filled out. Obtain from the school nurse.)

PART 2: LICENSED PRESCRIBER TO COMPLETE.

1.Relevant Diagnosis(es): ______________________________________________________________

2.Student’s General Health Status: _______________________________________________________

3.Medication: ________________________________________________________________________

4.Strength of medication: ___________________ Dosage (amount to be given): ___________________

 

Check Route: ❑ By mouth ❑ By inhalation ❑ Other __________________________

 

Frequency ____________________________ Time of each dose _____________________

 

___________________________________________________________________________

 

School medication orders shall be limited to medication that cannot be administered before or after

 

school hours. Special circumstances must be approved by school nurse.

5.

Duration of medication order: ❑ Until end of school term

❑ Other ____________________

6.Desired Effect: _____________________________________________________________________

7.Possible side-effects of medication: ____________________________________________________

8.Any contraindications for administering medication: ________________________________________

_________________________________________________________________________________

9.Other medications being taken by student when not at school:

_________________________________________________________________________________

_________________________________________________________________________________

10.Next visit is: _____________________________________

___________________________________________________________________________________

Prescriber’s Name (Printed)AddressPhone and Fax Numbers

__________________________________________________________________________________________

Prescriber’s Signature

Credential (i.e., MD, NP, DDS)

Date

Each medication order must be written on a separate order form. Any future changes in directions for medication ordered require new medications orders. Orders sent by fax are acceptable. Legibility may require mailing original to the school. Orders to discontinue also must be written.

PART 3: LICENSED PRESCRIBER TO COMPLETE AS APPROPRIATE.

Inhalants / Emergency Drugs

Release Form for Students to be Allowed to Carry Medication on His/Her Person

Use this space only for students who will self-administer medication such as asthma inhaler.

 

1. Is the student a candidate for self-administration training?

❑ Yes

❑ No

2.Has this student been adequately instructed by you or your staff and demonstrated competence in self- administration of medication to the degree that he/she may self-administer his/her medication at school, provided that the school nurse has determined it is safe and appropriate for this student in his/her particular

school setting? ❑ Yes ❑ No

3. If training has not occurred, may the school nurse conduct a training program? ❑Yes ❑ No

_____________________________________________________________________________

Licensed Provider’s Signature

Date

Misconceptions

Understanding the State of Louisiana Medication Order form is crucial for parents, guardians, and school staff. However, several misconceptions can lead to confusion. Here’s a breakdown of ten common myths surrounding this important document:

  1. Only licensed prescribers can fill out the form. While a licensed prescriber must complete the medical information, a parent or legal guardian must also fill out part of the form, ensuring that consent is given.
  2. Medications can be administered at any time during school hours. This is not true. Medications listed on the order form can only be given at school if they cannot be administered before or after school hours, unless special circumstances are approved by the school nurse.
  3. One medication order form can cover multiple medications. Each medication must be documented on a separate order form. This ensures clarity and proper management of each medication.
  4. Parents do not need to provide consent for medication administration. A parental or legal guardian consent form is mandatory. This form must be completed and submitted alongside the medication order form.
  5. Faxed orders are not acceptable. In fact, orders sent by fax are permissible, although the original may need to be mailed for legibility purposes.
  6. School staff can administer any medication without specific instructions. This is a misconception. Detailed instructions regarding dosage, frequency, and administration route must be provided by the licensed prescriber.
  7. Students can carry any medication with them at school. Only specific medications, like asthma inhalers, may be carried by students, and they must be deemed capable of self-administration by a licensed prescriber.
  8. Once a medication order is submitted, it cannot be changed. Changes in medication directions require new orders. This ensures that the most current information is always on file.
  9. There are no consequences for not following the medication order. It is essential to adhere to the medication order as outlined. Failure to do so can lead to health risks for the student.
  10. Only the school nurse can administer medication. While the school nurse plays a key role, unlicensed personnel may also administer medications under the guidance and training provided by the school nurse.

By clarifying these misconceptions, parents and guardians can better navigate the medication process at school, ensuring their children receive the care they need.

Documents used along the form

The State of Louisiana Medication Order form is essential for ensuring that students receive the necessary medications while at school. However, there are several other forms and documents that often accompany this medication order to provide a comprehensive approach to student health and safety. Below are five commonly used documents.

  • Parental/Legal Guardian Consent Form: This form is crucial as it provides the necessary consent from a parent or legal guardian for a student to receive medication during school hours. It ensures that the school has permission to administer the prescribed medication and is typically obtained from the school nurse.
  • Health History Form: This document gathers important information about the student’s medical history, allergies, and any previous health issues. It helps the school staff understand the student’s health background and aids in making informed decisions regarding their care.
  • Emergency Action Plan: For students with specific medical conditions, such as asthma or severe allergies, this plan outlines the steps to take in case of an emergency. It includes details about symptoms, necessary interventions, and contact information for parents or guardians.
  • Medication Administration Record (MAR): This record is used by school personnel to track when medications are given to students. It helps ensure that medications are administered correctly and on schedule, providing accountability and a clear history of medication administration.
  • Hold Harmless Agreement: When considering liability protections, review our important Hold Harmless Agreement considerations to ensure adequate coverage and legal clarity.
  • Inhalants/Emergency Drugs Release Form: This form is specifically for students who may need to carry and self-administer inhalers or other emergency medications. It confirms that the student has been trained in self-administration and that the school nurse deems it safe for them to do so.

Each of these documents plays a vital role in the overall health management of students in the school environment. By ensuring that all necessary forms are completed and submitted, parents, guardians, and school staff can work together to support the health and well-being of students effectively.