• Authority to Administer Medication - Short Term

  • (This form is for specific short-term reasons e.g. antibiotics for an infection.)
    (The prescribed medication needs to be accompanied by a medical authority form – please attach.)

  • In the interest of children’s safety and well-being, the centre shall only administer medication in its original container with the dispensing label attached listing the child as the prescribed person, strength of drug and frequency it is to be given.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • :
  • Please complete the table and list any detailed instructions in the box eg route (eg oral, inhaler), dose (eg thin layer, number of drops/mls/tablets) before or after food.

  • Date Format: MM slash DD slash YYYY
    • Date

    • Dosage

    • Time to be given

    • Time actually given

    • Signature of staff administering mediation

    • Signature of staff cross-checking mediation

    • Comments

    • Date Format: MM slash DD slash YYYY
    • Date Format: MM slash DD slash YYYY
    • Date Format: MM slash DD slash YYYY
    • Date Format: MM slash DD slash YYYY
    • Date Format: MM slash DD slash YYYY
    • Date Format: MM slash DD slash YYYY
    • Date Format: MM slash DD slash YYYY
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