Medication Record Childs name: ......................................................................................................... Date of birth: ................................................................................................... To be completed by the parent/guardian To be completed by the educator when administered Signature of Name of Last To be Medication Dosage Method of medication administered administered administered Administration parent/Guardian (or circumstances witness educator be to be of of of witness educator to administered) of of Time Date Time Date Method Time Date Dosage Name Name administered administration administering Signature administering Signature
Medication Record Childs name: ......................................................................................................... Date of birth: ................................................................................................... To be completed by the parent/guardian To be completed by the educator when administered Name of medication Last administered To be administered (or circumstances to be administered) Dosage to be administered Method of administration Signature of parent/Guardian Medication administered Dosage Administration Method of Name of educator administering Signature of educator administering Name of witness Signature of witness Time Date Time Date Time Date