Name of Organization Section:
Last Approval Date: Policy: Administration of Corresponding Forms:
Latest Approval Date: Medication Medication Authorization
Policy Number: Form
Sample Statement A: (Program Name) shall administer only drugs or medication in
accordance with the Ministry of Children and Youth Services guidelines and the
following (Program Name) guidelines.
Ref: DNA: R.R.O. 1990, Reg. 262, s. 37
Sample Statement B: (multi statement policy)
1) Prescription medications, in original container bearing child’s name, date of
purchase, dosage etc., will be administered at (program name) when written
parental consent has been granted.
2) The Supervisor or designate will administer the medication in accordance with
3) Medications are stored in accordance with instructions and are kept locked and
inaccessible to children. Exception: emergency asthma and allergy medications.
4) Appropriate records will be kept using the Medication Authorization Form and
kept along with the child’s confidential information for (length of time).
1) Before medication can be administered, parents/guardians are required to complete
and sign the Medication Authorization Form. The following information is required to
be completed on the form:
a) The exact name of the prescription drug and expiry date must be written in full.
b) The amount/dosage to be given.
c) The exact time it is to be given.
d) The required beginning and end date of administration of the medication.
e) The child’s full name.
g) Symptoms to look for prior to administration.
h) The side effects which may occur and the steps that should be taken in the event
of these side effects.
i) The parent must sign and date the form.
1) Remove the medication from the locked box.
2) Check the original container with the pharmacist’s label for the correct information:
a) Name of the child.
b) Name of the medication
d) Instructions for storage.
e) Date if was dispensed and the expiry date.
Note: if the medication is not in the original package with the pharmacist’s label or
any of the information is incorrect or out of date, medication will not be administered.
Medication is to be given directly from the container to the child, and not left
available to other children.
3) Check that the parent has completed the Medication Authorization Form.
4) Identify the symptoms to look for.
5) Check the required time and dosage of the medication.
6) Administer the medication. If you are uncertain of the correct procedure you should
request that the parent obtain a note of explanation from the physician. Proper
hygiene must be observed at all times. If the child administers the medication
him/herself, observe the child taking the medication to ensure that it has been taken.
7) Return the medication to the locked container.
8) Each time medication is given, a signature is necessary on the Medication
Authorization Form. This verifies that the medication was administered at the
9) Observe the child for any effects from the medication. It is often helpful to ask the
parent if the child has received this medication before while at home. If it is the first
dose of the medication, program staff should be very aware of the child and
accurately note any response.
10) It the child has an adverse response to the medication, care for the child and then
notify the parent(s) and the program supervisor.
11) Leftover or surplus medication must be returned to the parent(s) in the original
12) In the event that a child has an ongoing medication, such as an inhaler or an Epi-
pen, ensure that the parent/guardian reviews and signs the Medication Authorization
Form every six months. This will ensure proper dosage and timing of medication.