Prescription or Non-Prescription Medication Note
Prescription or Non-Prescription Medication Note Student Name: _____________________________________ Grade: _____________________ Name of Medication (even cough drops): ______________________________________________ Dosage or Amount to be given: _______________________ Time to be given: ________________ Duration to be kept at school (circle one) Entire School Year This Week (send home Friday) Today Only Parent Signature: ___________________________________ Date: ________________________ ** ALL Medications are to be in the original bottle. No exceptions. The First Dose is not to be taken at school**
Prescription or Non-Prescription Medication Note Student Name: _____________________________________ Grade: _____________________ Name of Medication (even cough drops): ______________________________________________ Dosage or Amount to be given: _______________________ Time to be given: ________________ Duration to be kept at school (circle one) Entire School Year This Week (send home Friday) Today Only Parent Signature: ___________________________________ Date: ________________________ ** ALL Medications are to be in the original bottle. No exceptions. The First Dose is not to be taken at school**
Prescription or Non-Prescription Medication Note Student Name: _____________________________________ Grade: _____________________ Name of Medication (even cough drops): ______________________________________________ Dosage or Amount to be given: _______________________ Time to be given: ________________ Duration to be kept at school (circle one) Entire School Year This Week (send home Friday) Today Only Parent Signature: ___________________________________ Date: ________________________ ** ALL Medications are to be in the original bottle. No exceptions. The First Dose is not to be taken at school**
Prescription or Non-Prescription Medication Note Student Name: _____________________________________ Grade: _____________________ Name of Medication (even cough drops): ______________________________________________ Dosage or Amount to be given: _______________________ Time to be given: ________________ Duration to be kept at school (circle one) Entire School Year This Week (send home Friday) Today Only Parent Signature: ___________________________________ Date: ________________________ ** ALL Medications are to be in the original bottle. No exceptions. The First Dose is not to be taken at school**
Prescription or Non-Prescription Medication Note Student Name: _____________________________________ Grade: _____________________ Name of Medication (even cough drops): ______________________________________________ Dosage or Amount to be given: _______________________ Time to be given: ________________ Duration to be kept at school (circle one) Entire School Year This Week (send home Friday) Today Only Parent Signature: ___________________________________ Date: ________________________ ** ALL Medications are to be in the original bottle. No exceptions. The First Dose is not to be taken at school**
