Medicine Administration Form
A few of our students may take prescription medicine before, or after school that may be out of the purview of Cambridge High School. Fulton County policy is that these prescriptions be administered by a Fulton County Employee and does not permit for students to carry the prescription on their person. These prescriptions will need to be turned in the morning of the trip in a bottle/container with the prescription described. Please do NOT submit this form without obtaining and completing the SHS-1 Health form, which can be found at this link: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.fultonschools.org/cms/lib/GA50000114/Centricity/Domain/267/Auth%20Med%20Form%20SHS1.pdf
Student Full Name
*
First Name
Last Name
Student Phone Number
*
Please enter a valid phone number.
Parent Full Name
*
First Name
Last Name
Parent Phone Number
*
Please enter a valid phone number.
Have you obtained a copy of the SHS-1 Fulton County Medicine Permissions Form found at the link at the top of this page?
*
Yes
No
Have you completed this SHS-1 Form with Physician Signature?
*
Yes
No, but in the process of obtaining signature.
Medication Information
Please provide details and descriptions of medications.
Prescription/Medicine
*
Dosage
*
Administration Time?
*
Morning
Afternoon
Evening
Time
*
Notes about Prescription?
Submit
Should be Empty: