Scout Prescription Medication Dosing Form
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1Prescription Medication Dosing Form
Atlanta Area Council-Boy Scouts of America
Name of Scout: __________________________________________________ Unit #: __________
Summer Camp Session/Date: _______________________________________ Campsite: _____________
Instructions to Note:
•
Each Scout that is taking prescription medications should have a separate form.
•
The form should be completed by the adult giving the medication. In the unit area, this is the unit leader or the designated unit health officer.
•
List each prescription medication the scout is receiving separately.
•
The adult / Scouter giving the prescription medications should put their name or initials by the time at which the scout was given the medication. If no
medication was given, leave the space blank.
Medication Name/ and frequency of administration
Medications
Medications
Medications
Medications
listed on the bottle:
given around
given around
given around
given at
NOTE: list each medication separately
Breakfast
Lunch
Supper
bedtime
(7-8 AM)
(12-1 PM)
(6PM)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
NOTE: If a scout is receiving more than three medications, use an additional form.
PrescriptionMedicationDosingForm-051608.doc
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