Brightside Nursery Infant School

Not Prescribed Medicine

This form is for medication such as paracetamol that has not been prescribed by your child's doctor.

Not prescribed Medicine Form

Name of child

Date of birth

Class

Name of medicine

Reason for medicine

Time of last dose

Dosage amount required

Self administration. Please write yes or no.

Name of parent/carer

Email address

I will notify school if there is any change to the above. I understand that a non-medical professional will administer my child’s medication. I confirm time of last dose and amount given. Please write yes or no.

Date

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Brightside Nursery Infant School

Not Prescribed Medicine

Not prescribed Medicine Form

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