Name of Child: Date medicine provided by parent: Name and Strength of medicine: Expiry Date: Date and Frequency of medication: Quantity returned: Date Time Medication Dose Any Reason Signature Given Given Given Given Reactions Appendix 11 OVER THE COUNTER MEDICATION DRUG MAXIMUM DOSE CONTRA-INDICATED USE IN Analgesics General Paracetamol 6-24 mths: 5ml Liver and kidney For relieving pain suspension 2-4 yrs: 7.5ml disease or history of and (120mg/5ml 4-8 yrs: 10ml paracetamol allergy. reducing a fever. Paracetamol, 8-10 yrs: 15ml E218, E216, 10-12 yrs: 20ml E420, Over 12 yrs: 20ml sucrose) Max x4 Doses in 24 hours. Calpol Fastmelts 6-9yrs 1 tab up to 4x per and kidney For relieving pain Six Plus day. disease or history of and reducing a (Paracetamol) 9-12 yrs 2 tabs up to 4x paracetamol allergy. fever per day. 12-16 yrs 2-3 tabs, up to 4 x per day.
Name of Child: Date medicine provided by parent: Name and Strength of medicine: Expiry Date: Date and Frequency of medication: Quantity returned: Date Given Time Given Medication Given Dose Given Reason Any Reactions Signature Appendix 11 OVER THE COUNTER MEDICATION DRUG MAXIMUM DOSE CONTRA-INDICATED IN USE Analgesics General Paracetamol suspension (120mg/5ml Paracetamol, E218, E216, E420, sucrose) 6-24 mths: 5ml 2-4 yrs: 7.5ml 4-8 yrs: 10ml 8-10 yrs: 15ml 10-12 yrs: 20ml Over 12 yrs: 20ml Max x4 Doses in 24 hours. Liver and kidney disease or history of paracetamol allergy. For relieving pain and reducing a fever. Calpol Fastmelts Six Plus (Paracetamol) 6-9yrs 1 tab up to 4x per day. 9-12 yrs 2 tabs up to 4x per day. 12-16 yrs 2-3 tabs, up to 4 x per day. and kidney disease or history of paracetamol allergy. For relieving pain and reducing a fever