Sample Medication Administration Log Name of Child: ______________________________ Date of Birth ______/______/______ Date Time Medication Dosage Name of Staff Person who (including any side effects noticed) administered Medication Permission Form is complete Medication is appropriately labeled Medication is in original container Date on is current Name of Person Accepting Medication: ________________________________________________________ Date: ________________________
Sample Medication Administration Log Name of Child: ______________________________ Date of Birth ______/______/______ Date Time Medication Dosage Name of Staff Person who administered (including any side effects noticed) Medication Permission Form is complete Medication is in original container Medication is appropriately labeled Date on is current Name of Person Accepting Medication: ________________________________________________________ Date: ________________________
Sample_Medication_Administration_Log.docx