Requests for
Medication Agreement Forms
Medication Letters for Customs & Travel or Webster Packs
To make a request,
Submit our Request Form below
Download, the appropriate SA Government Medication Form (see below), complete the parent/guardian section and send it to your doctor via our admin email address.
The Government Medication Agreement Form should also be completed to detail medications, dose and administration in regard to Customs or Travel Letter or Webster Pack Letter Requests.
Your submitted Request Form and the Government Form will then be filed for your specialist to complete the medical section or compose the required letter.
Your doctor may take several weeks to complete this or may require an appointment to be booked to complete the Request.
For each medication, when completing the Government Form, be sure to specify the
name;
strength;
form
liquid, drops, capsules, tablets, chewable, gummies, topical such as cream, lotion, inhaler, injection;
amount of medication for each dose
e.g. 1.5 tablets, 5 ml, 2 drops, etc.;
the time the medication dose should be given
this covers giving the medication up to 30 minutes before or after this time;
How it is administered, such as
Swallowed with water, fruit juice or cordial, milk, yoghurt etc
Dissolved in water, fruit juice or cordial, milk, etc.
Suck or chew
aurally (in-ear), topically, etc.
2 puffs of inhaler
injected in upper thigh, etc
The following forms are linked to and can be downloaded from https://www.education.sa.gov.au/parents-and-families/student-health-and-disability-support/health-and-complex-needs-support-and-management/medication-management-education-and-care-services#agreements-and-plans
Medication Agreement Form (for one medication)
Multiple Medication Agreement Form (for 2 to 4 medications per Form)
Emergency Medication Plan- Seizure Management Form (for Midazolam administration)
Will an appointment be needed?
An appointment will often be needed for a complex medication plan.
Several of the associated providers prefer to complete these requests in an appointment.
Otherwise, providers may be happy to complete the form outside of an appointment but will charge a fee for this work.
Forms and letters may take several weeks when provided outside an appointment.
The fee for the Form/Letter Request:
Form or Letter Request Fees are detailed in your Provider’s Fee Schedule. The link to this Schedule can be emailed, but it is normally and routinely provided in each Booking Email. The Fee will be invoiced when you have submitted the request and should be paid to proceed with the Request.
Please phone to make the payment or email a copy of your bank’s remittance advice to show the payment. We will send a receipt.
If your doctor advises they need to complete the requested form or letter in an appointment, the Request Fee will be changed to an Account Deposit for that appointment.
Do I need my Specialist to complete the required form or letter?
Your GP can normally complete these Medication Forms and Letters. Check with them to see if they are happy to do so.
Parents can generally complete Medication Agreement Forms for as-needed or occasional pain relief such as Panadol or Nurofen, Melatonin, antiseizure meds, Fluoxetine, asthma medications, Clonidine and other non-Schedule 8 Medications.
Your Specialist or GP must complete the medical section of the Medication Agreement Forms for Schedule 8 controlled drugs such as Opioids, Stimulants, Oxygen, Insulin, and regular pain relief.