Revised | Originally Published: July 3, 2021 @ 4:48 pm

Overview

Use the Prescription Medication Permission And Log to document all prescription medications administered to children in your early learning setting. It is essential to ensure 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
• The dosage
• The dates administering the medication should start and end
• The time(s) the medication should be administered
• How the medication should be administered
• The composition of the medication
• Possible side effects
• How the medication should be stored
• Any additional instructions related to the medication

Prescribing Physician Information

In this section of the Prescription Medication Permission And Log, enter the name, address, and phone number of the physician 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 authorizing that the medication be given and acknowledging that they have provided accurate and complete information about the medication.

Prescription Medication Administration Log

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

The form also includes a space to attach a current picture of the child. Doing so can be a valuable safeguard, especially in larger early learning programs with many children and where multiple staff members handle medications.

It may be seen as overkill, but a photo helps ensure the correct medication is administered to the right child, reducing the danger of human error.

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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