Authorization For The Administration Of Medication Form - Cheshire Community Ymca Page 2

ADVERTISEMENT

Medication Administration Record (MAR)
Child’s Name__________________________
Prescriber’s Name_________________________
Medication____________________________
Method of Administration___________________
Dosage_______________________________
Pharmacy Name _________________________________ Prescription Number ______________
Date
Time
Dosage
Signature of
Comments
Person
Giving Medicine
BEFORE ANY MEDICATION CAN BE ADMINISTERED FOR THE FIRST TIME, THE FOLLOWING MUST BE IN PLACE:
The authorization form is complete.
( ) Yes
( ) No
The medication is in a safety container.
( ) Yes
( ) No
The original prescription label is on the medication container.
( ) Yes
( ) No
The name of the child is on the container.
( ) Yes
( ) No
The date on the prescription is current. (Within the month
( ) Yes
( ) No
for antibiotics and with the expiration date for medication
which are so labeled)
Staff Signature___________________________________________________ Date ________________________

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Authorization For The Administration Of Medication Form Authorization For The Administration Of Medication Form Medical
Authorization For The Administration Of Medication By School, Child Care, And Youth Camp Personnel Authorization For The Administration Of Medication By School, Child Care, And Youth Camp Personnel Business
Form 1/2012 Sgk - Authorization For The Administration Of Medicine By School Personnel Form 1/2012 Sgk - Authorization For The Administration Of Medicine By School Personnel Medical
Authorization For The Release Of Medical Records Authorization For The Release Of Medical Records Legal
Parent/guardian Authorization For The Administration Of Non-prescription Topical Medications By Child Care Personnel Parent/guardian Authorization For The Administration Of Non-prescription Topical Medications By Child Care Personnel Legal
School Log For The Administration Of Medication To Students School Log For The Administration Of Medication To Students Education
Hipaa-compliant Authorization For The Release Of Medical Information Pursuant To 45 Cfr 164.508 Hipaa-compliant Authorization For The Release Of Medical Information Pursuant To 45 Cfr 164.508 Medical
Patient Authorization For The Release Of Medical Information Form Patient Authorization For The Release Of Medical Information Form Legal
Form 0857k - Authorization For Limited Release Of Medical Information - Department Of Veteran Affairs - Form 0857k - Authorization For Limited Release Of Medical Information - Department Of Veteran Affairs - Legal
Authorization For The Release Of Information Under The Privacy Act Authorization For The Release Of Information Under The Privacy Act Legal

Related Categories

Parent category: Business
Download
Go
Page of 2