(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.
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
Dosage
Time to be given
Time actually given
Signature of staff administering mediation
Signature of staff cross-checking mediation
Comments
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It is very important that you let these people know that you have nominated them. In nominating them you give them authority to act on the child's behalf if neither parent can be located, to pick up the child in an emergency and care for the child until she can be returned home.
The people nominated have been given approval ONLY to collect the child and should NOT be contacted in an emergency.
Does the parent/guardian/carer of this child have any of the following?
If this child attends another funded Preschool program please complete the following: