Scribd Logo
Upload

Welcome to Scribd!

  • Physicians Order

    Uploaded by

    api-249923118
    10 views1 page
    Newmarket Junior-Senior High School provides contact information for its principal Chris Andriski, assistant principal Chris Mazzone, director of guidance Thomas Pavlidis, and guidance counselor Kristin Eberl, as well as special education coordinator Chris O'Callahan. The document also includes a form requiring a physician's order and signature for any prescription medication a student needs while at school, with fields to provide the student's name and date of birth, diagnosis, doctor's contact details, medication name and dosing, start and end dates, and any restrictions.

    Original Description:

    Original Title

    physicians order

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Newmarket Junior-Senior High School provides contact information for its principal Chris Andriski, assistant principal Chris Mazzone, director of guidance Thomas Pavlidis, and guidance counselor Kristin Eberl, as well as special education coordinator Chris O'Callahan. The document also includes a form requiring a physician's order and signature for any prescription medication a student needs while at school, with fields to provide the student's name and date of birth, diagnosis, doctor's contact details, medication name and dosing, start and end dates, and any restrictions.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    10 views1 page

    Physicians Order

    Uploaded by

    api-249923118
    Newmarket Junior-Senior High School provides contact information for its principal Chris Andriski, assistant principal Chris Mazzone, director of guidance Thomas Pavlidis, and guidance counselor Kristin Eberl, as well as special education coordinator Chris O'Callahan. The document also includes a form requiring a physician's order and signature for any prescription medication a student needs while at school, with fields to provide the student's name and date of birth, diagnosis, doctor's contact details, medication name and dosing, start and end dates, and any restrictions.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    Newmarket Junior-Senior High School

    213 South Main Street


    Newmarket, New Hampshire 03857-1898
    603-659-3271 Fax: 603-659-1287
    www.newmarket.k12.nh.us/

    Chris Andriski

    Principal

    Chris Mazzone

    Assistant Principal

    Thomas Pavlidis

    Director of Guidance

    Kristin Eberl

    Guidance Counselor

    Chris OCallahan

    Special Education Coordinator

    Physicians Orders for Medication in School


    Our policy requires all prescription medication, for use in school, must have a signed and dated Doctor's order on file each year.

    Date:____________
    Name of Student:________________________________ D.O.B.___________________
    Diagnosis: ______________________________________________________________
    Doctor:________________________________ Phone#__________________________

    Name of Medication: ___________________________ Dose: ______________________


    Times: __________________________________________________________________
    Start Date: __________________________ End Date: ___________________________
    Any
    Restrictions:______________________________________________________________________________________________________
    _________________________________________________________________________________________________________________
    ____________________

    If Asthma medication, please include Asthma Action Plan, including Peek Flows.

    Physicians Signature:_________________________________________ Date:___________________________

    You might also like