Permission to give prescribed medication
This form should be completed by a Parent/Carer on each occasion a pupil is prescribed medication by a medical professional which needs to be taken whilst in school. Medications must be provided in their pharmacy container with the pharmacy label attached. The medication may be for a long term medical condition or for a short term need (e.g. antibiotics). Over the counter medications will not be given in school. Please refer to the school First Aid and Medication Policy for further information.
Pupil Name
*
Pupil First Name
Pupil Last Name
Prescription Medication Name
*
Reason for medication
*
Provide reason why medication has been prescribed and any other supporting information
Date Started
*
-
Day
-
Month
Year
Date course will end (if applicable)
-
Day
-
Month
Year
Date
Dose
*
mg, ml, units, drops, etc.
Frequency
*
daily, weekly, etc.
Parent/Carer Name
*
Parent/Carer First Name
Parent/Carer Last Name
Parent/Carer Signature
*
Submit
Should be Empty: