Sacred Heart Catholic Primary School

Child to Carry Their Own Medicine

For use only when this requirement has been advised by a healthcare professional and this has been confirmed by the school. This form must be completed by a parent/carer. A child should only carry their own medicine if they are able to administer the medicine independently. If more than one medicine is to be given a separate form should be completed for each one. If the period of administering medicine is 8 days or more, we will discuss an Individual Healthcare Plan with you.

Your child's full name

Your child's date of birth

Your full name

Your relationship to the child

Date

Name and strength of medicine

Date dispensed

Expiry date

Dosage and method

Timing

Special instructions or precautions

Please specify any side effects we need to know about

Procedures to take in an emergency

Name of GP

Telephone number of GP

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Sacred Heart Catholic Primary School

Child to Carry Their Own Medicine

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