Transcription of ADHD Management Plan/Sample 1 - …
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ADHD Management Plan/Sample 1 - …
1mgDose 2mgDose am/pmTimeam/pmDose 1mgDose 2mgDose 3mg Medication to be given on nonschool days Medication given fornumber of days School authorization signed by parent and MD Rx written for duplicate bottle for administration at school Side effects explained/information givenCommon Side Effects:decreased appetite, sleep problems, transient stomachache, transient headache, behavioral reboundCall your doctor immediately if any infrequent side effects occur:weight loss, increased heart rate and/or blood pressure,dizziness, growth suppression, hallucinations/mania, exacerbation of tics and Tourette syndrome (rare) adhd Management plan Sample 1 Date:To t h e f a m i l y o f, please refer to this plan between visits if you have questions about you are still unsure, call us at for s doctor isPager #Parent/GuardianRelationshipContact Number(s)School NameSchool Phone Teacher Contact Name Grade Teacher s E-mail AddressGoal
HE0351 NICHQ Vanderbilt Assessment Scale—TEACHER Informant Te acher’s Name: _____ Class Time: _____ Class Name/Period: _____
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