ࡱ> HJGc Ybjbj** .,HSbHSbv < < 8 Lv*tlllllGGG)))))))$+.*GGGGG*ll0*mmmGRll)mG)mmA(|)l#"?f()F*0v*(&/?.&/$)&/)(GGmGGGGG**mGGGv*GGGG&/GGGGGGGGG< B ~: Medication Plan Confidential To be completed by the PRESCRIBING DOCTOR and the PARENT/GUARDIAN for a child who requires supervision of medication while at childcare. This information is confidential and will be available only to supervising staff and emergency medical personnel. To the Doctor Please: Complete all sections of this form. Schedule medication outside childcare hours when ever possible. Be specific: As needed is not sufficient direction for staff members they need to know exactly when the medication is required. Nominate the simplest method. For example Oral or puffer medication is much easier to arrange than a nebuliser. Please note that childcare staff: Accept only medication that has been ordered by a doctor and is provided in the original, fully labelled pharmacy container. Do not monitor the effects of medication as they have no training to do this. Are instructed to seek emergency medical assistance if concerned about a childs behaviour following medication. Name of child ... DOB .. Family name First name (please print) Medic Alert number (if relevant) ... Review date This plan applies from: / / until / / incl. (please include all days) MEDICATION INSTRUCTIONS (Please print clearly) Medication Name and form (eg liquid, capsule, ointment) Dose Method (eg oral or inhaled/both eyes/right ear only) Any other instruction: Illness being treated by this medication: TIME (Please indicate exact times relevant to child care) Early morning at: Mid morning at: Middle of the day at: Mid-afternoon at: Evening at: Other (please specify) Any other medication being taken at this time (ie at home)  Please note: Children are supervised when they take their oral/puffer medication. Age appropriate, safe self-management is encouraged. AUTHORISATION AND RELEASE Medical Practitioner . Professional Role .. Address Telephone Signature Date .. I have read, understood and agreed with this plan and any attachments above. I approve release of this information to childcare staff and emergency medical personnel. Parent or Guardian .. Signature Date Office use only: Copy to Date Name and signature of distributor Room/section: Computer (if ongoing plan): Original to confidential file: (Last updated March 2020)     Adelaide Vlog Childcare Services Inc Waite/Adelaide Campus Childrens Centre Acknowledgement to Department of Education South Vlog, Health Support Planning 2001. Information adapted from this source. 4FO^ ' / 5 # N  ; T s w x  yht5OJQJ\^JhtOJQJ^Jht6CJOJQJ]^Jht5CJOJQJ\^JhtCJOJQJ^JhtCJOJQJ^Jht5CJ\ htCJht5CJ\ht5CJ\ht5CJ\ htCJ htCJht/  ' / S  ( v ! $ & F$d&dNPa$$ & F$d&dNPa$$$d&dNPa$$a$! 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