Common use of BE ADVISED Clause in Contracts

BE ADVISED. It is the Parents/Guardians responsibility to pick up student medication by student dismissal the last day of the school. Medications left unclaimed will be disposed of according to the Colorado Department of Human Services (CDHS) “Guidelines for Medication Administration (2008).” Signature of Parent or Guardian Month/Day/Year PRIMARY CARE PROVIDER (PCP) SIGNED ORDER FOR MEDICATION This form must be completed for any medication a student will need to take during school hours. Please be aware that any medications, including samples, must have a medication label to be administered at school. Student’s Name: Grade: Date of Birth: / / Medication/Treatment Name (one per form) Dosage: Route: Frequency: Times given at School: / / Starting date: Ending date: or until end of school year 2018-2019 / / Purpose of Medication: Allergies: NKDA Other: _ Possible Side Effects: _ (Print) Name of PCP or Dentist Prescribing Medication Phone: Fax: Signature of PCP w/Prescriptive Authority Medication Discontinued: Time: Date: / / and Date: Clinic Name: / / PCP Signature: _ / Date: / / (Print) Name of School Nurse Signature of School Nurse School Nurse Signature indicates that the medication and medication orders have been reviewed by School RN

BE ADVISED. It is the Parents/Guardians responsibility to pick up student medication by student dismissal the last day of the school. Medications left unclaimed will be disposed of according to the Colorado Department of Human Services (CDHS) “Guidelines for Medication Administration (2008).” Signature of Parent or Guardian Month/Day/Year PRIMARY CARE PROVIDER (PCP) SIGNED ORDER FOR MEDICATION This form must be completed for any medication a student will need to take during school hours. Please be aware that any medications, including samples, must have a medication label to be administered at school. Student’s Name: Grade: Date of Birth: / / Medication/Treatment Name (one per form) Dosage: Route: Frequency: Times given at School: / / Starting date: Ending date: or until end of school year 20182017-2019 2018 / / Purpose of Medication: Allergies: NKDA Other: _ Possible Side Effects: _ (Print) Name of PCP or Dentist Prescribing Medication Phone: Fax: Signature of PCP w/Prescriptive Authority Medication Discontinued: Time: Date: / / and Date: Clinic Name: / / PCP Signature: _ / Date: / / (Print) Name of School Nurse Signature of School Nurse School Nurse Signature indicates that the medication and medication orders have been reviewed by School RN

BE ADVISED. It is the Parents/Guardians responsibility to pick up student medication by student dismissal the last day of the school. Medications left unclaimed will be disposed of according to the Colorado Department of Human Services (CDHS) “Guidelines for Medication Administration (2008).” Signature of Parent or Guardian Month/Day/Year PRIMARY CARE PROVIDER (PCP) SIGNED ORDER FOR MEDICATION This form must be completed for any medication a student will need to take during school hours. Please be aware that any medications, including samples, must have a medication label to be administered at school. Student’s Name: Grade: Date of Birth: / / Medication/Treatment Name (one per form) Dosage: Route: Frequency: Times given at School: / / Starting date: Ending date: or until end of school year 20182020-2019 2021 / / Purpose of Medication: Allergies: NKDA Other: _ Possible Side Effects: _ (Print) Name of PCP or Dentist Prescribing Medication Phone: Fax: Signature of PCP w/Prescriptive Authority Medication Discontinued: Time: Date: / / and Date: Clinic Name: / / PCP Signature: _ / Date: / / (Print) Name of School Nurse Signature of School Nurse School Nurse Signature indicates that the medication and medication orders have been reviewed by School RN