Parental Agreement for School to Administer Prescribed MedicineParental Agreement for School to Administer Prescribed Medicine • January 9th, 2019
Name of child: Gender: Male / Female Date of birth: Class: Medical diagnosis,condition or illness: MEDICINE Name/type of medicine (asdescribed on the container) Expiry Date Dosage & method of administration When to be given Special Precautions or otherinstructions. eg. with food etc Side effects that school must knowabout Can the child self-administer Y/N If YES, is supervision required? Yes / No Procedures to take in anemergency
ContractParental Agreement for School to Administer Prescribed Medicine • December 21st, 2015
Parental Agreement For School To Administer Prescribed MedicineParental Agreement for School to Administer Prescribed Medicine • March 25th, 2015
Date for review to be initiated by Name Tutor Medical condition or illness Medicine Name/type of medicine(as described on the container) Expiry date Dosage and method Timing Special precautions/other instructions Are there any side effects that the school needs to know about? Self-administration – yes/no Procedures to take in an emergency NB: Medicines must be in the original container as dispensed by the pharmacy Contact Details Name Telephone Relationship to Student Address
PARENTAL AGREEMENT FOR SCHOOL TO ADMINISTER PRESCRIBED MEDICINEParental Agreement for School to Administer Prescribed Medicine • November 23rd, 2020
The school will not give your child medicine unless you complete and sign this form. The school has a policy that staff can administer medicine. Medicine prescribed 3 times a day should be administered at home (before school, after school and at bedtime)
PARENTAL AGREEMENT FOR SCHOOL TO ADMINISTER PRESCRIBED MEDICINEParental Agreement for School to Administer Prescribed Medicine • May 2nd, 2019
DATE CHILD’s NAME CLASS MEDICAL CONDITION / ILLNESS NAME OF MEDICINE EXPIRY DATE DOSAGE REQUIRED TO BE GIVEN AT WHAT TIME ON WHICH DAYS (please circle) MON TUE WED THUR FRI TIME OF PREVIOUS DOSAGE (if taken) ARE THERE ANY POSSIBLE SIDE EFFECTS? CAN YOUR CHILD SELF-ADMINISTER? PROCEDURE TO TAKE IN AN EMERGENCY CONTACT DETAILS Name: Daytime contact no.: Relationship to child:
PARENTAL AGREEMENT FOR SCHOOL TO ADMINISTER PRESCRIBED MEDICINEParental Agreement for School to Administer Prescribed Medicine • February 7th, 2017
The school will not give your child medicine unless you complete and sign this form, and the school has a policy that staff can administer medicine.
Loughton SchoolParental Agreement for School to Administer Prescribed Medicine • June 14th, 2021
FORM 3Parental Agreement for School to Administer Prescribed Medicine • October 4th, 2017
PARENTAL AGREEMENT FOR SCHOOL TO ADMINISTER PRESCRIBED MEDICINEParental Agreement for School to Administer Prescribed Medicine • September 11th, 2017
The school will not give your child prescribed medicine unless you complete and sign this form and the school has a policy that staff may administer medicine.
PARENTAL AGREEMENT FOR SCHOOL TO ADMINISTER PRESCRIBED MEDICINEParental Agreement for School to Administer Prescribed Medicine • November 5th, 2020
The school will not give your child medicine unless you complete and sign this form, and the school has a policy that staff can administer medicine.
PARENTAL AGREEMENT FOR SCHOOL TO ADMINISTER PRESCRIBED MEDICINEParental Agreement for School to Administer Prescribed Medicine • September 22nd, 2017
Name/type of medicine (as described on the container) Date dispensed Expiry Date: Dosage and method Time to be administered Special precautions/other instructions Are there any side effects that the school needs toknow about? Self administration YES/NO Procedures to take inemergency
GREENHAUGH PRIMARY SCHOOLParental Agreement for School to Administer Prescribed Medicine • January 26th, 2022
School will not give your child medicine unless you complete this form, and the school has a policy that staff can administer prescribed medicine.
PARENTAL AGREEMENT FOR SCHOOL TO ADMINISTER PRESCRIBED MEDICINEParental Agreement for School to Administer Prescribed Medicine • January 28th, 2019
Should my daughter’s salbutamol inhaler not be available (for example, because it is broken or empty) I give consent for the school to administer the emergency salbutamol inhaler in the case of an asthma attack.
Parental Agreement for School to Administer Prescribed Medicine (short term use)Parental Agreement for School to Administer Prescribed Medicine • September 8th, 2017
Name of child Date of birth Medical Condition/Illness Class Member of staff responsible Name of medicine (as described on the container) Date dispensed/ / Agreed finish/review date Expiry date / / Dosage and method Timing Special precautions Procedures to take in an emergency Are there any side effects school needs to know about? Note: Medicines Must Be In The Original Container As Dispensed By Pharmacy Contact details: NameDaytime telephone no Relationship to child Address
PARENTAL AGREEMENT FOR SCHOOL TO ADMINISTER PRESCRIBED MEDICINEParental Agreement for School to Administer Prescribed Medicine • May 18th, 2015
The school will not give your child medicine unless you complete and sign this form, and the school has a policy that staff can administer medicine.
