The Oak Tree South - Emergency Care Plan

Childs Name
Date

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Description of medical condition
Steps to be taken to prevent complications
Signs andor symptoms that warrant immediate action
In the event of a medical emergency or allergic reaction, please list the names, doses, and methods of prompt administration of medication(s) required. A Medication Authorization Form is required for each medication to be administered. If more than three medications are necessary, please attached additonal pages as necessary.
Name of Medication
Dosage
Method:
Other
Name of Medication
Dosage
Method:
Other
Name of Medication
Dosage
Method:
Other
Additional instructions and comments
Our personnel shall notify parents or guardians immediately of any suspected complications or injuries related to the condition. Our personnel shall also contact 911 as necessary to receive further instructions.
Upload medical notes

Cancelof
ParentGuardians Signature
Date

MonthDayYear
Date
Should be Empty: