Medication Consent Form 22/23
Parent to complete prescribed medicines to be brought into school
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Електронна адреса *
Name of Child *
Medical Need (Illness with child) *
Year Group *
Class *
Name of medication and reason for taking *
We are permitted to give medicines once a day during school hours please indicate the time. For medicines to give 4 times daily we suggest - 8.00am, 12noon school, 3.30pm and then before bed.  For 3 times a day we suggest Breakfast, after the school day and then bedtime. *
Only for pupils who attend after school club Explorers - permission to give an after school dosage on four times a day at 4pm. *
Dosage *
Duration of course - number of days/weeks *
I will ensure the school has adequate supplies of this medication *
Обов’язково
A doctor or hospital have prescribed the medicine it is correctly labelled and dated in the original packaging. *
I give permission for a member of staff who has received appropriate training in accordance with the School Medical Policy and Local Authority code of practice *
Signed (Please write your name in full) - your email will be the evidence of your signature. *
Date *
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ММ
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РРРР
Копії ваших відповідей буде надіслано на вказану електронну адресу.
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КонфіденційністьУмови
Цю форму створено в домені Southfields Primary School. Повідомити про порушення
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