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Gateways – Medication Administration


This form should be completed in consultation with the student's medical practitioner for all medication to be administered at school and whilst attending excursions or school camps.

Student Name(Required)
MM slash DD slash YYYY
Medication to be administered at school:
Name of Medication
Dosage (amount in mg or ml)
Duration Dates
Time/s to be taken
How is it to be taken? (eg oral/topical/injection)
How is it stored
Expiry Date of Drug
Medication delivered to the school
Please ensure that medication delivered to the school:
Please describe what supervision or assistance is required by the student when taking medication (e.g. remind, observe, assist or administer):
MM slash DD slash YYYY