Form Ccl.027 - Authorization For Dispensing Medications To Children And Youth Long-Term Medications (Prescription And Non-Prescription) Page 2
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2*Signature of Person Administering Medication ___________________________________ Initialing as ____________
*Signature of Person Administering Medication ___________________________________ Initialing as ____________
*Signature of Person Administering Medication ___________________________________ Initialing as ____________
*Signature of Person Administering Medication___________________________________ Initialing as ____________
Note Form
Date
Additional comments about the incident or other related incidents, including
comments or remarks about the child’s or youth’s appearance and/or condition.
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