•	To be completed by the foster carer on all occasions when any non-regularly prescribed and/or administered medication is given in an emergency or at any time  – prescribed and non-prescribed;
•	Non-prescribed medication - (see section in Fostering Handbook on home remedies if unsure about when to use non-prescribed medication).  Such medication will include items such as Calpol, linctus paediatric/simple linctus, paracetamol, ibuprofen;
•	Please complete in ink and clearly, so that the writing can be read by others;
•	PRN means “as required”.
Please outline any foods or drinks which cannot be taken with any of the medication and any intolerances:	
	Cannot be taken with		
	Cannot be taken with		
Intolerances are:		
AN EXAMPLE OF COMPLETED MEDICATION IS ON THE NEXT PAGE
Route = route of administration: O = Oral; E = External; I = Injection; W = With Food

Name of Child	Date of Birth	Service User Number		
Emergency or non-regularly prescribed/ administered medication	Date	Route	Times and initials of carer	

									

									

									

									

									

									

									

									

									

									

Handover (where appropriate)	Yes/No	Signature	Name (foster carer) and date	
Is this form fully up-to-date?				
Form received by me today:				
Quality Assurance	Yes/No			
Form – any comments/further action needed			Name (Child’s Social Worker) and date	
Form – any comments/further action needed			Name (Supervising Social Worker) and date	

EXAMPLE OF EMERGENCY OR NON-ROUTINELY ADMINISTERED MEDICATION FOR JOE BLOGGS WHO HAS THREE DIFFERENT TYPES OF MEDICATION, FOUR TIMES A DAY:

Name of Child: Joe Bloggs	Date of Birth: 04.02.2002	Service user number: 123456	
Medication and date prescribed	Dose	Frequency	Comments	
Amoxicillin 12.02.10	2.5 ml	Every 4 hours	FINISH ALL 5 DAYS DOSE	
Calpol 12.02.10	2.5 ml	Every 8 hours	Alternate with Ibruprofen PRN	
Ibuprofen 12.02.10	5.0 ml	Every 8 hours	Alternate with Calpol PRN	

EXAMPLE OF COMPLETED RECORD BELOW FOR JOE BLOGGS

Emergency or non-regularly prescribed/administered medication	Date	Route	Time and initials of carer	
			08:00	12:00	16:00	20:00			
Amoxicillin 2.5 ml	12/02/10	O	DP	DP	DJP	MP			
Calpol 2.5 ml	12/02/10	O		DP					
Ibuprofen 5.0 ml	12/02/10	O	SD		DJP