LDSS-7000. Health Care Plan for the Administration of Medication for Legally-Exempt Provider

Form LDSS-7000, Health Care Plan for the Administration of Medication for Legally-Exempt Provider, is used to provide the New York State Office of Children and Family Services (OCFS) with the necessary information to grant formal approval for a legally-exempt provider to administer medication to children in their care.

This form consists of seven sections. The first section is an introduction and contains instructions for completing the form. The second section is for use by the legally-exempt provider and includes a Provider Information section, a Medication Administration Policy section, and a Signature section. The third section is for use by the physician and includes a Physician Information section and a Signature section. The fourth section is for use by the parent and includes a Parent Information section and a Signature section. The fifth section is for use by the child's guardian and includes a Guardian Information section and a Signature section. The sixth section is for use by the legally-exempt provider and includes a Medication Administration Training section and a Signature section. The seventh and final section is for use by the legally-exempt provider and includes a Medication Administration Log section and a Signature section.

Important fields in this form include the provider's name and contact information, the physician's name and contact information, the parent's name and contact information, the guardian's name and contact information, information about the medication to be administered, the medication administration policy, and the signature of all involved parties. Specific instructions for completing the form include providing complete and accurate information, and signing and dating the form. It is important for the form to be filled out accurately and completely, as the form is necessary for the legally-exempt provider to be granted formal approval to administer medication to children in their care.

This form could be used in a situation where a legally-exempt provider is seeking formal approval from the OCFS to administer medication to a child in their care. The benefits of using this form include providing the OCFS with the necessary information to properly approve the legally-exempt provider, and providing the provider with the necessary documentation to administer medication to the child in their care.

Specific instructions for filling out this form include providing complete and accurate information and signing and dating the form. Related forms include Form LDSS-7001, Medication Administration Plan, which must accompany this form. Additional documents