Homepage Free State Of Louisiana Medication Order Template
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Navigating the healthcare needs of students during school hours requires precise coordination between parents, healthcare providers, and school personnel. The State of Louisiana Medication Order form epitomizes this collaborative effort, designed to ensure students receive the necessary medications safely while at school. This comprehensive form, to be completed by a licensed prescriber from Louisiana, Texas, Arkansas, or Mississippi, is critical for the administration of medication by unlicensed personnel - a common practice in many schools. The form encapsulates vital information, from the student's diagnosis and general health status to the specific medication, dosage, and administration instructions. It places emphasis on medications that must be given during school hours, underscoring that only those which cannot be administered outside of these hours should be considered. Moreover, it includes provisions for parental consent, a mandatory prerequisite, and guidelines for emergency drugs or inhalants, delineating when a student may carry and self-administer medication. Additionally, the requirement for separate forms for each medication and the protocol for modifications or discontinuation ensure clarity and up-to-date information. A unique aspect is the consideration for students capable of self-administering medications, such as asthma inhalers, contingent upon adequate training and assessment of competence. This form is a testament to the collaborative approach necessary for the well-being of students requiring medication during school, underlining the importance of detailed, clear communication among all parties involved.

Form Example

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

Document Breakdown

`
Fact Detail
Prescriber Eligibility Must be licensed in Louisiana, Texas, Arkansas, or Mississippi
Form Sections Three parts: Parent/Guardian, Licensed Prescriber, Emergency Drugs Release
Consent Requirement Parental or legal guardian consent necessary
Administration Guidelines Medication typically administered by unlicensed personnel
Medication Limitations Only for medication that cannot be administered before or after school hours
Order Validity Separate form required for each medication; Changes necessitate new orders
Governing Law Louisiana state law oversees the implementation of this form

Instructions on Filling in State Of Louisiana Medication Order

The State of Louisiana Medication Order form is an essential document for students requiring medication during school hours. It's a bridge between healthcare providers, parents or legal guardians, and the school system, ensuring that students' medicinal needs are safely and effectively met. Completing the form accurately is vital for the well-being of the student and to comply with state regulations. Follow the steps below to fill out the form correctly.

Part 1: To be filled out by the Parent or Legal Guardian
  1. Enter the student's full name where indicated.
  2. Fill in the student's birthdate.
  3. Write the name of the school the student attends and their current grade.
  4. Print the name of the student's parent or legal guardian.
  5. Parent or legal guardian must sign and date the form. Remember, a separate parental/legal guardian consent form is also required and can be obtained from the school nurse.
Part 2: To be completed by a Licensed Prescriber Information about the Medication
  1. State the relevant diagnosis(es) for which the medication is prescribed.
  2. Describe the student’s general health status.
  3. Provide the name of the medication required.
  4. Indicate the strength of the medication and the dosage amount to be given.
  5. Check the appropriate route of administration (by mouth, by inhalation, or other) and specify the frequency and time of each dose. Note that school medication orders are typically for medications that cannot be administered before or after school hours without special approval.
  6. Specify the duration of the medication order.
  7. Describe the desired effect of the medication.
  8. List any possible side effects of the medication.
  9. Include any contraindications for administering the medication.
  10. Mention other medications the student takes when not at school.
  11. Indicate the date for the next medical visit.
  12. Print the prescriber’s name, address, and phone and fax numbers.
  13. Prescriber must sign and date the form, including their credential (e.g., MD, NP, DDS).
For Self-Administration of Inhalants/Emergency Drugs
  1. Indicate whether the student is a candidate for self-administration training.
  2. Confirm if the student has been adequately instructed and is competent in self-administration, ensuring it's safe for the student to carry and use the medication at school.
  3. If training has not been conducted, state whether the school nurse may conduct a training program.
  4. The licensed provider must sign and date this section.

Each medication order must be submitted on a separate form. Any changes to the medication or its administration require a new form. While faxed orders are permitted, it may be necessary to mail the original for legibility. Instructions to discontinue medication must also be documented.

Listed Questions and Answers

Who needs to complete the State of Louisiana Medication Order form?

The State of Louisiana Medication Order form must be completed by two parties. First, a parent or legal guardian of the student must fill out Part 1 of the form. This section requires the student’s name, birth date, school, grade, and the parent or legal guardian's name and signature. Secondly, a Louisiana, Texas, Arkansas, or Mississippi licensed prescriber is required to complete the subsequent sections, providing detailed information about the student’s medication regimen.

What type of medication can be administered at school, according to the form?

According to the form, school medication orders are specifically limited to medications that cannot be administrated before or after school hours. This means any medication included on the form must be essential during school time. Special circumstances, however, may be approved by the school nurse, indicating there is some flexibility depending on the student's health requirements.

Can the medication order be changed once it has been submitted?

Yes, any future changes in the directions for medication ordered require new medication orders. This means if the dosage, frequency, or type of medication changes, a new form must be completed and submitted to the school. Additionally, orders sent by fax are acceptable, but in cases of legibility issues, mailing the original form to the school might be necessary. Orders to discontinue a medication also must be clearly written and submitted.

Is it possible for a student to carry and self-administer medication?

Yes, students may be allowed to carry and self-administer medication, such as an asthma inhaler, under certain conditions. The prescriber must indicate whether the student is a candidate for self-administration training and confirm that the student has been adequately instructed and can competently self-administer the medication. If training has not occurred, the prescriber can agree to allow the school nurse to conduct a training program. Final approval for a student to self-carry medication depends on the school nurse's determination of its safety and appropriateness in the school setting.

What are the procedures for a student taking other medications when not at school?

The prescriber must list any other medications the student is taking when not at school. This information helps the school staff understand the student's overall medication regimen and monitor for any potential interactions or side effects that could impact the student's health and safety while at school. By providing a complete list of medications, caregivers and school personnel can ensure a comprehensive approach to the student’s healthcare management during school hours.

Common mistakes

When filling out the State of Louisiana Medication Order form, individuals often overlook or inaccurately complete critical sections, resulting in delays or errors in the administration of necessary medications to students. Highlighted below are eight common mistakes to watch for:

  1. Omitting essential information in Part 1, which is reserved for the parent or legal guardian. This section requires complete details concerning the student, including their name, birthdate, school, and grade, as well as the printed name and signature of the parent or guardian. Neglecting to fill any of this information out can result in the form being considered invalid.

  2. Failing to secure a parental/legal guardian consent form alongside the medication order form is a crucial oversight. These consent forms are necessary for the school nurse to legally administer medication.

  3. Incomplete details regarding the diagnosis or general health status of the student in the section required by the licensed prescriber (Part 2). This lack of information can leave school personnel without a clear understanding of the student's medical needs.

  4. Inaccuracies in specifying the medication details, such as the medication name, strength, dosage, route, frequency, and time of each dose. Precision in this area is vital to ensure the safe and correct administration of medication.

  5. Not clearly indicating the duration of the medication order. Without this, school personnel might not know how long to administer the medication, potentially leading to the premature cessation or unnecessary prolongation of treatment.

  6. Overlooking the section that outlines the desired effect of the medication, possible side effects, and any contraindications. This information is essential for monitoring the student's response to the medication and identifying any adverse reactions.

  7. Not listing other medications the student is taking when not at school. This information can prevent harmful drug interactions and side effects by giving a comprehensive view of the student's medication regimen.

  8. Failing to complete the inhalants/emergency drugs release form for students authorized to carry medication on their person. Specific criteria must be met for students to self-administer medication, such as demonstrating competence and receiving approval from both the prescriber and the school nurse.

Being meticulous while completing the State of Louisiana Medication Order form is paramount. Both parents or legal guardians and licensed prescribers play crucial roles in this process, ensuring students' health needs are safely and effectively met during school hours. Avoiding the errors mentioned can significantly contribute to the wellbeing of students requiring medication at school.

Documents used along the form

When it comes to medication management in educational settings in Louisiana, the State of Louisiana Medication Order form plays a crucial role in ensuring that students receive their prescribed medications safely and accurately during school hours. This document, however, often goes hand-in-hand with other forms and documents to provide a comprehensive approach to a student's health and medication needs. Understanding these accompanying documents can greatly enhance the efficacy and safety of medication administration at school.

  • Parental or Legal Guardian Consent Form: This form is essential for obtaining explicit permission from a parent or legal guardian for the school to administer medication to their child, as mentioned in the medication order form.
  • Medication Administration Record (MAR): An MAR tracks all the medications a student takes while at school, documenting each dose administered, the time, and the person who administered it to maintain an accurate record.
  • Student Health Information Form: This encompasses a comprehensive overview of the student's health, including allergies, chronic conditions, and other relevant health issues, aiding the school in providing tailored care.
  • Emergency Contact Form: Should an adverse reaction to a medication or a health emergency occur, this document ensures school officials have immediate access to contact information for the student's parent or guardian.
  • Allergy Action Plan: For students with known allergies, this plan details the steps to be taken in case of an allergic reaction, including the administration of emergency medications like epinephrine.
  • Asthma Action Plan: Similar to the Allergy Action Plan, this document provides specific instructions for managing a student's asthma at school, including when and how to use an inhaler or nebulizer.
  • Individualized Healthcare Plan (IHP): For students with chronic health conditions, an IHP is developed collaboratively by the school nurse, healthcare providers, and the family, detailing all health services the student requires during the school day and how to provide them.

Each of these documents plays a vital role in creating a safe and supportive environment for students who require medication during school hours. By working together, parents, healthcare providers, and school personnel ensure that students' healthcare needs are met with accuracy and care, minimizing health-related disruptions to their education. Understanding the purpose and importance of each document can greatly empower parents and guardians as they navigate the administration of medication in schools.

Similar forms

The State Of Louisiana Medication Order form is similar to several other important documents used in medical and educational settings. These documents are crucial for ensuring students' health needs are met safely and effectively while they are at school. Understanding how the Medication Order form resembles and differs from these documents can provide clarity and reassurance for parents, legal guardians, and healthcare providers.

Medical Consent Forms: Like the Medication Order form, medical consent forms are used to authorize medical treatment or procedures. Both documents require the signature of a parent or legal guardian if the patient is a minor. The main difference lies in their specific purpose: medication order forms are specifically for the administration of medication at school, whereas medical consent forms can cover a broad range of medical interventions. Additionally, medical consent forms are often used in hospitals or clinics, while medication order forms are tailored for school settings.

Prescription Slips: Prescription slips, issued by licensed healthcare providers, authorize a pharmacy to dispense medication to a patient. They resemble the State Of Louisiana Medication Order form in that they both specify the medication, dosage, and how it should be administered. However, the medication order form is uniquely designed for school use, including details relevant to the school environment like the student’s name and school information. Unlike typical prescription slips, the medication order form also requests information on possible side effects and contraindications specific to the school setting.

Individual Healthcare Plans (IHPs): IHPs are comprehensive, customized documents that outline the management of a student's specific health needs at school. They often incorporate medication orders as a component of the student's care. IHPs and the Louisiana Medication Order form share the goal of ensuring student health and safety. However, the Medication Order form is more narrowly focused on medication administration, while IHPs cover a broader range of health management strategies, including actions to take in the event of an emergency, routine healthcare procedures, and accommodations for participation in school activities.

Asthma Action Plans: Asthma Action Plans are specialized forms that provide specific instructions for managing a student's asthma at school, including the use of prescribed medications like inhalers. These plans are similar to the medication order form when it concerns the authorization and instructions for medication use. Yet, they also include detailed guidance on recognizing asthma symptoms and steps to take for various levels of asthma exacerbation, making them more detailed in the management of this specific condition.

Through understanding the similarities and differences between the State Of Louisiana Medication Order form and these related documents, stakeholders can better navigate the protocols for managing student health needs in educational settings. Each document plays a vital role in ensuring students receive the care they need, when they need it, in a manner that is safe and appropriate within the school context.

Dos and Don'ts

When filling out the State of Louisiana Medication Order form, attention to detail is crucial for ensuring the safe and efficient administration of medication to students by school personnel. Below is a guide on what you should and should not do:

Do:

  • Ensure all information is complete and accurate, especially the student's name, birthdate, and medication details.

  • Use legible handwriting to prevent any misunderstandings or errors in medication administration.

  • Provide clear instructions on the dosage, frequency, and route of administration to facilitate correct usage.

  • Include any relevant diagnosis and health status that the school personnel might need to be aware of.

  • Specify the duration of the medication order, whether it's until the end of the school term or another specific timeframe.

Don't:

  • Leave any sections incomplete. If a section does not apply, make sure to indicate this by writing "N/A" or "None".

  • Assume school staff have the same medical knowledge as a licensed prescriber. Avoid medical jargon and explain terms if necessary.

  • Forget to obtain parental or legal guardian consent, as this is a required step in the process.

  • Overlook the importance of discussing potential side effects and contraindications for the prescribed medication.

  • Submit the form without the prescriber’s signature, credential, and date, as these are critical for the form’s validity.

Misconceptions

When it comes to managing students' medication needs, schools in Louisiana must adhere to specific protocols outlined in the State of Louisiana Medication Order form. However, several misconceptions about this form and its requirements often arise. Here are eight common misunderstandings and the realities behind them:

  • Any school employee can administer medication. In reality, most instances require that medications be administered by unlicensed personnel, often after receiving proper training, unless otherwise indicated by specific school policies.
  • Parental consent is optional. A common misconception is that parental or legal guardian consent isn't strictly necessary. In truth, part of the form requires completion by a parent or legal guardian, emphasizing the need for consent and their involvement in the process.
  • One form can cover multiple medications. Each medication a student needs during school hours must have a separate order form. This measure ensures clarity and safety in administering medications.
  • Faxed orders are not permitted. While legibility concerns may necessitate mailing the original document, orders sent by fax are acceptable. This convenience helps in timely updates to a student's medication needs.
  • The form allows medication administration for any reason. Medication orders are limited to instances where medication cannot be administered before or after school hours, unless special circumstances are approved by the school nurse.
  • Informal updates to medication orders are adequate. Any future changes in the directions for medication ordered require new medication orders. This formality helps prevent mistakes and ensures the student's safety.
  • Students cannot carry their medication. There is a specific section in the form for inhalants/emergency drugs, allowing self-administration by students deemed competent and safe to do so in their particular school setting.
  • All students' medication needs are publicly known. The details of a student's medication needs are handled with confidentiality, shared only among those directly involved in administering or overseeing the process.

Understanding these aspects of the State of Louisiana Medication Order form helps ensure that students receive their medications safely and effectively during school hours, with the proper oversight and consent involved in the process.

Key takeaways

The State of Louisiana Medication Order form is an important document used to ensure that students can receive necessary medications during school hours. This form requires detailed information and appropriate signatures from both a parent or legal guardian and a licensed prescriber. To accurately complete and use the form, consider the following key takeaways:

  • The form must be completed by a licensed prescriber from Louisiana, Texas, Arkansas, or Mississippi. This ensures that the student receives medication prescribed by a professional familiar with state regulations and standards of care.
  • Part 1 of the form requires information and a signature from the student's parent or legal guardian. This part gathers basic information about the student and grants permission for medication administration at school.
  • A separate consent form must be obtained and filled out by the parent or legal guardian, in addition to this medication order form. The school nurse usually provides this consent form.
  • The prescribing healthcare provider must include detailed information about the student’s diagnosis, general health status, the medication prescribed, including its strength and dosage, and the method and frequency of administration. This ensures that unlicensed personnel administering the medication have clear instructions.
  • Medication orders are restricted to those that cannot be administered before or after school hours unless special circumstances are approved by the school nurse. This guideline is designed to minimize classroom interruptions and ensure the student receives medication when it is most effective.
  • Any changes to the medication order, including discontinuations, require a new form to be completed and submitted. This precaution ensures that medication administration records are current and accurate.
  • The form also includes a section for the prescriber to endorse whether the student is allowed to carry and self-administer emergency drugs, such as an asthma inhaler. This decision is based on the student’s ability to manage their medication responsibly.

All sections of the form must be filled out accurately and legibly, with all necessary signatures obtained, to ensure the student's safety and compliance with school policies. In some instances, a faxed copy of the form is acceptable, but legibility issues may require the original document to be sent to the school.

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