Date Signed ……………………………………………… [The headteacher/head of setting/named member of staff] Form 4: Record of medicine stored for and administered to an individual learner Name of setting Name of learner Date medicine provided by parent Group/class/form Quantity received Name and strength of medicine Expiry date Quantity returned Dose and frequency of medicine Staff signature ………………………………………………………
Date Signed ……………………………………………… [The headteacher/head of setting/named member of staff] Form 4: Record of medicine stored for and administered to an individual learner Name of setting Name of learner Date medicine provided by parent Group/class/form Quantity received Name and strength of medicine Expiry date Quantity returned Dose and frequency of medicine Staff signature ………………………………………………………