Sample Medicine Record

 

PERMISSION TO ADMINISTER MEDICINE

 

I give permission for medicine to be administered to my child whilst in the care of Rosanne’s Childminding Services.

 

NAME OF MEDICINE

 

DATE

 

REQUIRED DOSE

 

ADMINISTRATION TIMES

 

FROM (DATE)                                            TO (DATE)

 

Please note: Welland Childcare will not administer doses of any medicine that a child has not previously taken (this is in the case of an allergic reaction).  Any medicine that is administered will be recorded in a medicine record and will require your signature for each occasion.

 

Signature (parent/s). __________________________________________________

 

Signature (childminder)________________________________________________

 

 

Copyright © Rosanne Podmore 2003