590 1-1 20(1)
Parental authorization, except for first aid, personnel should 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; the dates to be given; the time of day to be dispensed; and signature of parent
I give (name of authorized person(s)
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.
BABY WIPESBAND-AIDSNEOSPORIN OR SIMILAR OINTMENTSBACTIN OR SIMILAR FIRST AID SPRAYSUNSCREENINSECT REPELLENTNON-PRESCRIPTION OINTMENT (SUCH AS A &D, DESITIN, VASELINE)BABY POWDER
Other (please specify)