• OREGON LEARNING EARLY DEPARTMENT DIVISION OF EDUCATION

    OREGON LEARNING EARLY DEPARTMENT DIVISION OF EDUCATION

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  • Prescription or non-prescription medication including but not limited to pain relievers, cough syrup, antihistamines, or nose drops, may be given to a child under the following conditions:

    1. A medication authorization form signed and dated by the parent is on file.

    2. Prescription medication is in the original container and labeled with the child's name, name of drug, dosage and directions for administering, date and physician's name.

    3. Non-prescription medication is in the original container, labeled with the child's name, dosage, and directions for administering.

    4. All medications are secured in a tightly-covered container with a child-proof lock or latch and stored so that they are not accessible to children.

    5. Medications requiring refrigeration are kept in the refrigerator in a separate tightly-covered container with a child-proof lock or latch, clearly marked medication.

    6. Parents are informed daily of medications administered to their child.

    7. Programs must immediately document the administration of any medication.

  • Date*
     / /
  • Does this medication require refrigeration:*
  • to dispense the above medication in accordance with

    the administration information.

  • Date*
     / /
  • Medication given by (signature)

    Potential side effects observed:

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  • Potential side effects observed:

    Potential side effects observed:

    Potential side effects observed:

    Oregon Department of Education Early Learning Division Office of Child Care www.oregonearlylearning.com (PR-0187) 11/15/22 Page 1 of 2

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  • Attach additional pages, if necessary. Completed medication should be returned to the parent. This record must be maintained in the child's file for at least two years.

    Oregon Department of Education Early Learning Division Office of Child Care www.oregonearlylearning.com (PR-0187) 11/15/22 Page 2 of 2

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