Example of medical administration chart in early childhood education?

Medical Administration Chart

Child's Name: ___________________________

Date: ___________________________

Medication: ___________________________

Dosage: ___________________________

Time to be Administered: ___________________________

Route: ___________________________

Special Instructions: ___________________________

Parent/Guardian Signature: ___________________________

Teacher Signature: ___________________________

Date and Time Administered: ___________________________

Date and Time Next Dose Due: ___________________________

Comments: ___________________________

Medical Administration Chart

Student Name: [Student Name]

Date of Birth: [Date of Birth]

Grade: [Grade]

Medications:

| Medication | Dosage | Route | Frequency | Time |
|---|---|---|---|---|
| Acetaminophen | 500 mg | Oral | Every 6 hours | As needed |
| Albuterol inhaler | 2 puffs | Inhaled | Every 4 hours | As needed |
| Erythromycin eye drops | 1 drop | Eye | Every 8 hours | 8:00 AM, 12:00 PM, 4:00 PM |

Administration Notes:

- Acetaminophen must be diluted in 2 ounces of juice or water before giving.
- Albuterol inhaler must be shaken well before each use.
- Erythromycin eye drops must be instilled directly into the affected eye.
- All medications must be stored in a locked cabinet out of reach of children.
- Parents will be notified if any medications are missed or administered incorrectly.

Emergency Contacts:

- Parent/Guardian: [Parent/Guardian Name]
- Phone Number: [Parent/Guardian Phone Number]
- Email Address: [Parent/Guardian Email Address]

Health Care Provider:

- Name: [Health Care Provider Name]
- Phone Number: [Health Care Provider Phone Number]
- Email Address: [Health Care Provider Email Address]

Additional Information:

- [Student Name] has [condition] that requires medication administration.
- The medication administration plan was developed in consultation with the student's health care provider.
- The teacher will closely monitor the student's response to the medication and report any concerns to the health care provider.

Signature of Health Care Provider:

[Health Care Provider Name]

Date: [Date]

Signature of Parent/Guardian:

[Parent/Guardian Name]

Date: [Date]