Consent to Support with Medication I give consent for ( company name) Care to arrange for a support worker to support me with the administration of my medication as prescribed by my GP (dentist, nurse, prescriber, or other authorised prescriber). Any changes or additions will need to be authorised in the same way. Signature of Individual ……………………………………………….. Name of Individual ……………………………………………….. Address of Individual ……………………………………………….. ……………………………………………….. Signature of Assessor ……………………………………………….. Name of Assessor ……………………………………………….. Contact Tel No. ……………………………………………….. Date of Assessment ……………………………………………….. Name of GP ……………………………………………….. This authorisation must be kept on the individuals file
Consent to Support with Medication I give consent for ( company name) Care to arrange for a support worker to support me with the administration of my medication as prescribed by my GP (dentist, nurse, prescriber, or other authorised prescriber). Any changes or additions will need to be authorised in the same way. Signature of Individual ……………………………………………….. Name of Individual ……………………………………………….. Address of Individual ……………………………………………….. ……………………………………………….. Signature of Assessor ……………………………………………….. Name of Assessor ……………………………………………….. Contact Tel No. ……………………………………………….. Date of Assessment ……………………………………………….. Name of GP ……………………………………………….. This authorisation must be kept on the individuals file
VquxzMedicationFile4-Consent.docx