Medicine Administration Form - Bedlinog Primary
Dear Parent/Carer,

In order for your child to be provided with prescribed medicine at school (which falls in line with our policy), please complete the following form. Please ensure that you send the medicine in it's original packaging with the pharmacy label visible.

Please ensure you have read the school medicine administration policy before completing this form. This can be accessed by going to: https://www.bedlinogprimary.wales/policies

Do not send in any medicines until you have completed the form below.

Many thanks
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이메일 *
Child's Name *
Child's Year Group *
Child's date of birth *
YYYY
/
MM
/
DD
Medicine being administered (Name/type of medicine described on the container) *
Date medicine was dispensed *
YYYY
/
MM
/
DD
Expiry date of medicine *
YYYY
/
MM
/
DD
Dosage and method *
When should the medicine be given? *
Are there any side effects the school should know about? *
Are there any specific procedures we would need to take in an emergency? If there are, please provide details. *
Please read the following before submitting:
I confirm that the above information is, to the best of my knowledge, accurate at the time of writing and I give consent to the school administering medicine in accordance with the school arrangements. I will inform the school immediately, in writing, if there is any changes in dosage or frequency of the medication or if the medication is stopped.

I understand that it is my responsibility to ensure the medicine gets to school safely, and that the school accepts no responsibility for any issues arising as a result of medication being given.
Parent Name *
Date *
YYYY
/
MM
/
DD
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