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Appendix A Camp Name: Dates: University of Wisconsin La Cross PART ONE: CONSENT FOR MEDICATION ADMINISTRATION and MEDICAL TREATMENT TO THE PARENT’S) OR LEGAL GUARDIAN: If your son, daughter, or
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How to fill out consent for medication administration

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How to fill out consent for medication administration:

01
Obtain the necessary forms: Start by acquiring the consent form for medication administration. This can usually be obtained from the healthcare facility or provider responsible for administering the medication.
02
Fill in personal information: Begin by filling in the required personal information of the individual who will be receiving the medication. This typically includes their full name, date of birth, address, and contact information.
03
Provide medical history: Include any relevant medical history or conditions that may affect the administration of the medication. This may include allergies, previous adverse reactions to medications, or any current medical conditions.
04
Specify the medication: Clearly state the name of the medication that will be administered. Include detailed information such as dosage, frequency, and any specific instructions or restrictions.
05
Consent options: Indicate the preferred method of consent. This can include options such as written consent, verbal consent, or electronic consent. Follow the guidelines provided by the healthcare facility or provider.
06
Signature and date: Ensure that the consent form is signed and dated by both the individual receiving the medication (or their legal guardian) and the healthcare provider responsible for administering it. This indicates that both parties understand and agree to the medication administration.

Who needs consent for medication administration?

01
Patients: Any adult patient or emancipated minor who is capable of giving informed consent will need to provide their own consent for medication administration. This is typically done by signing the consent form.
02
Parents or legal guardians: For minors or individuals who are unable to provide informed consent, parents or legal guardians will generally need to give consent on their behalf. They should ensure they are fully informed about the medication being administered and any potential risks or side effects.
03
Healthcare professionals: Healthcare professionals, such as doctors or nurses, may also need to provide consent for medication administration in certain circumstances. This can include situations where they are administering medication without the patient's direct consent, such as in emergency situations or when caring for individuals who are unable to provide consent themselves.
Remember, the specific requirements for consent may vary depending on the jurisdiction and healthcare facility. It is important to follow the guidelines provided by the healthcare professionals involved in the medication administration process.
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