Medication Log Page 2
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MEDICATION LOG
TIME
MEDICATION INFO
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DRUG:
DOSAGE:
ROUTE:
REASON:
DATE START:
DATE END:
SP. DIR.:
I, the parent or guardian of the above child give permission for the above medication to be administered.
Signature
Date
DATE
TIME
COMMENTS
NAME OF PERSON ADMINISTERING
INITIALS
ROUTES OF ADMINISTRATION:
ORAL (BY MOUTH)
EYE DROPS (OPTIC)
NOSE DROPS (SPRAY) (NASAL)
EAR DROPS (OTIC)
TOPICAL (ON SKIN)
OCCL Medication Log, version 2005
Page 2 of 2
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Parent category: Medical