Overview

Use the Prescription Medication Permission And Log for documenting all prescription medications administered to children in your early learning setting. It is important to assure that all medications are handled and administered appropriately.

Using The Prescription Medication Permission And Log Form

Note: It is best to print the two pages of this document on the front and back of one sheet of paper so that the details of the prescription and log remain together. This makes for easier document management. Additional logs can be printed and attached to the primary document for long term prescriptions.

Here’s an overview of how to use this form:

Child And Medication Information

In this section, you enter:

• The child’s name and birthdate
• The name of the medication to be administered
• Any known side effects of the medication
• How the medication is to be administered
• The dose to be given and when it is to be given
• The start and end dates for administration of the medication
• Any additional instructions related to the medication–whether they need to be refrigerated, for example

Prescriber Information

In this section of the Prescription Medication Permission And Log, enter the name, address, and phone number of the person who prescribed the medication.

Permission To Give Medication

In this section, add the printed name, contact information, and signature of the child’s parent or guardian.

Prescription Medication Administration Log

Each time the medication is administered, log the date, time, dose given, and any related comments. Then the person giving the child the medication should sign the document.

Here’s The Prescription Medication Permission And Log Form

Download it, print it, and use it to help keep everyone in your setting safe and healthy:

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