Medication Administration Record

ADVERTISEMENT

Medication Administration Record
ALL MEDICATIONS MUST BE IN THE ORIGINAL CONTAINER WITH PHYSICIAN’S INSTRUCTIONS. OTC MEDS MUST BE
IN ORIGINAL MANUFACTURER PACKAGING. MEDS IN UNMARKED PACKAGING WILL NOT BE ADMINISTERED.
Meds will not be given to minors without a sponsor present. Meds will be given to sponsors to dispense.
Please place medication bottles in a Ziploc bag clearly labeled with child’s first and last name.
Primary dispensing times for medications will be at each meal unless otherwise noted by a physician.
Medication must be turned in to medical personnel upon arrival at camp for security purposes. NO medications
(prescribed or OTC) or vitamins are allowed to be kept in the cabins.
Please circle at which meal your child takes his/her medication.
Fill out shaded column only; daily columns are for the medical personnel use only.
Camper Name: __________________________________________ DOB: __________________ M/F: _______
Parent/Guardian Name: _____________________________________ Phone Number: ___________________
Medical Allergies: ___________________________________________________________________________
Parent/Guardian Signature: ___________________________________________________________________
Medication Name and
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
Times Taken
Breakfast
Dinner
Lunch
Bed Time
Breakfast
Dinner
Lunch
Bed Time
Breakfast
Dinner
Lunch
Bed Time
Breakfast
Dinner
Lunch
Bed Time
Breakfast
Dinner
Lunch
Bed Time

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Medical
Go