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PARTNERSHIP MATTERS
A Guide to Local Authorities, NHS Boards and Voluntary Organisations on Supporting Students with Additional Needs in Further Education
ANNEX A
SAMPLE FORM - STUDENTS WITH MEDICATION NEEDS
As outlined in section 3.1.14, further education providers may wish the student to provide written confirmation of their medication requirements and procedures to be followed in an emergency.
The following information is likely to be most helpful to the further
education provider.
Name
Programme of Study
Address
Condition or illness
Name of medicine
Procedures to be followed in an emergency
Name and daytime telephone number of person to be contacted in an emergency
Relationship to student
Declaration:
I understand that the college has put in place a reasonable adjustment to allow my medication to be administered by a health professional, parent, carer or by myself. I understand that the information given by me in this form will be held in the strictest confidence by the college.
I have given my consent to the following people administering
medication to me.
Names of authorised individuals:
Signed
Date
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