Yogies Playhouse Medication Record
Child Name:
DOB:
Please be advised that we cannot administer any medication without a letter from the doctor, or a
chemist sticker with the correct name and dosage clearly written on it.
To be completed by Parent/Guardian
Name of Medication
Dosage
Last Administered
Time
Date
Method of administration
Parent Name
To be completed by Educators
Name of Medication
Medication Administered
Time
Date
Administered by
Name
To be administered next
Time
Date
Dosage Administered
Witnessed by
Name
Signed
Parent Signature
Expiry Date
Signed
To be completed by Parent/Guardian
Name of Medication
Dosage
Last Administered
Time
Date
Method of administration
To be administered next
Time
Date
Parent Name
Parent Signature
To be completed by Educators
Name of Medication
Administered by
Name
Medication Administered
Time
Date
Signed
Dosage Administered
Witnessed by
Name
Expiry Date
Signed
Page | 1
Yogies Playhouse Medication Record
To be completed by Parent/Guardian
Name of Medication
Dosage
Last Administered
Time
Date
Method of administration
To be administered next
Time
Date
Parent Name
Parent Signature
To be completed by Educators
Name of Medication
Administered by
Name
Medication Administered
Time
Date
Dosage Administered
Witnessed by
Name
Signed
Expiry Date
Signed
To be completed by Parent/Guardian
Name of Medication
Dosage
Last Administered
Time
Date
Method of administration
To be administered next
Time
Date
Parent Name
Parent Signature
To be completed by Educators
Name of Medication
Administered by
Name
Medication Administered
Time
Date
Signed
Dosage Administered
Witnessed by
Name
Expiry Date
Signed
Page | 2