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Authorization to Dispense External Preparations Form

Authorization to Dispense External Preparations

590-1-.20(1)

Parental Authorization:  Except for first aid, personnel shall not dispense prescription or non-prescription medications to a child without specific written authorization from the child’s physician or parent.  Such authorization will include, when applicable, date; full name of the child; name of the medication; prescription number, if any; dosage; dates to be given; the time of day to be dispensed; and signature of parent.

I give More Than Preschool staff permission to apply one or more of the following topical ointments/preparations to my child in accordance with the directions on the label of the container.
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