ECC Medical Form

Required

- Short Term Treatment of Illness as Prescribed by a Doctor

The medication must:

Be prescribed to the child with visible pharmacy labels.
Have original packaging.
Be handed over to a staff member every morning and picked up by the parent at the end of the day.

Please be aware that:

Over the counter medications will not be approved or administered.
Ideally, medication should be given outside of school hours if possible.
Please see ISB Guidelines for Handling of Medicines for more information.

Once this form is filled in, parents are responsible for sending the completed form in a toddle message to both the class teacher and the ECC principal.

Student name

Class

Name of medication

Dosage

Times to be administered

First date of administration of medication in the ECC

Must contain a date in MM/DD/YYYY format

Last date of administration of the medication in the ECC

Must contain a date in MM/DD/YYYY format

Name person(s) authorised to administer the medicine(s) listed below

The medication will be kept:

If uncertainties occur, ISB is authorised to contact the dispensing physician:

Name of doctorrequired

Prefix (optional)

First Name

Last Name

Medical centre

Doctor telephone number

Information and training have been given to the named persons above.

By submitting this...

I declare that I have been in dialogue with my child’s class teacher regarding the administration of this medication.

Parent name

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ECC Medical Form

- Short Term Treatment of Illness as Prescribed by a Doctor

If uncertainties occur, ISB is authorised to contact the dispensing physician: