STUDENTS
507.2E1 - RECORD OF THE ADMINISTRATION OF PRESCRIPTION MEDICATION
Name of Student:
Parents' Phone Number: Grade:
Medication:
Date to Begin: Date to End:
Dosage: Time:
Prescriber or person authorizing administration:
Phone #1: Phone #2:
Possible Adverse Reaction:
Person(s) Authorized to Administer Medication: .
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Date Given
Time
Dosage Given
Signature of Employee Administering Medication
Comments
Reviewed 10/16/2023