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Medication administration procedure

This form is to be completed by the carer and/or support worker responsible for administering medication to the client in the home environment.

By completing this form, you are confirming that you have reviewed the medication details authorised by the treating GP, that you understand the correct administration procedure, dosage and frequency, and that you are aware of any side effects to monitor.

Please complete one acknowledgement per client. If you have any concerns about the medication or administration procedure, do not complete this form - contact our team on 03 5561 8888 or the treating GP before proceeding.

Applicant details

Full legal name

Date of birth

Email address

Acknowledgement

I have read the new medication administration procedure listed above.

I understand my responsibilities in relation to this procedure.

I have had the opportunity to ask questions and seek clarification where required.

I agree to follow the procedure at all times when administering, handling or supporting medication.

I understand that failure to comply with this procedsure may place service users at risk and may result in further action in line with organisational policy.

I acknowledge that I am responsible for applying this procedure in my role.

Signature

Manager/case worker confirmation (if required)

I confirm that the above-named carer has been informed of the new medication procedure and given appropriate guidance.

Worker name

Job title

Authorisation

Signature