Prescription & Non-prescription Medicines

This form is to be completed by parents/carer’s/member of staff detailing information when a student is required to take prescription/non-prescription medicines during school hours.

The College will only accept prescription medicines if they are in-date, labelled, provided in the original container as dispensed by a pharmacist and include instructions for dosage and storage. Non-prescription medication (eg paracetamol) must be provided in the original container showing the expiry date and should include instructions for dosage.

Student Name:

Form:

Date:

Student Address:

Parent/Carer/Staff Name:

Parent/Carer/Staff Signature:

Register of Medication Received (Parent/Carer/Staff)

Date:

Who brought medicine in (Parent/Carer/Staff)

Medication Name

Amount Supplied

Expiry Date

Dosage Regime

Register of Medication Administered (Staff)

Date (optional)

Medication Name (optional)

Dosage (optional)

Amount Left (optional)

Time Taken (optional)

Administered By (optional)

Comments/Action/Side Effects (optional)