Medication administration form with a dose log
Parent permission, medicine details and a dose log on one page. Add your center details, edit the wording and download.
- Fill in your detailsYour center, room and dates.
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Each section below shows what will print. Use the switch to keep or remove a section, edit the policy wording, and add your own questions at the bottom.
Your own questions
OptionalSafe medication practices in childcare
- Only give medicine with signed parent permission. Some states also need a doctor's note.
- Keep medicine in the original container with the child's name.
- Store medicine locked, and refrigerate if the label says so.
- Check the 5 rights every time: right child, medicine, dose, time and route.
- Write down every dose right away, with the time and your initials.
- Return or throw away old medicine safely.
Many states require staff training before giving medicine. Check your licensing rules. Related: allergy form, health history form.
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Common questions
What is a daycare medication administration form?
A form where parents give written permission for staff to give a medicine, with the medicine name, dose, times and instructions, plus a log of every dose given.
Can daycare give over-the-counter medicine?
Usually only with signed parent permission, and some states also require a doctor's note. Check your state's licensing rules.
What are the 5 rights of medication?
Right child, right medicine, right dose, right time and right route. Check all five before every dose.
Is this medication form free?
Yes. Add your details and download a printable form at no cost.