Part I is for the parent or guardian to complete and Part III for the principal or principal designee; page 2 holds parent or guardian information about medication procedures.
First dose: the first dose of any new medication must be given at home with the exception for a rescue medication.
Supply: the parent or guardian must provide FCPS and SACC a supply of medication to be administered during the school day and in SACC.
Containers: all prescription medications must be in their original containers and labeled by a licensed prescriber or pharmacist in English.
Stationery: a licensed prescriber may use office stationery or a prescription pad in lieu of completing Part II.
| Question | Answer |
|---|---|
| Form Name | Form SS/SE-63 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 59 |
| Avg. time to fill out | 10 min |
| Edition | Rev 5/25 |
| Other names | SS/SE-63, SS SE 63, FCPS medication form, Fairfax County medication authorization, Fairfax medication authorization form |
| Official source | Form SS/SE-63 (Rev 5/25), Fairfax County Public Schools |
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