CAMP ATLANTIC DIRECTIONS FOR ADMINISTERING MEDICATION

(This form must accompany any medication sent or brought to the Beach Houses)

Name of Camper

Birth Date

SS#

Your E-Mail Address:        

Medications	Date Prescribed	Reason for Medication
1.
2.
3.
4.
5.
6.

Medication is to be administered as follows:

Time Given	Name of Medication	Quantity
BEFORE BREAKFAST
BREAKFAST
MID MORNING
LUNCH
AFTERNOON
DINNER
EVENING
BEDTIME

MEDICATION TO BE GIVEN ONLY AS NEEDED:

Indication

Name of medication

Quantity

Have you included enough medication for the length of stay?

yes no

Name of Camper/Parent/Guardian	Date
Name of Physician	Date