Foster Parent(s) *
Foster Parent(s)
Foster Child *
Foster Child
Placement Date *
Placement Date
Fill in "01" for Day. Month and Year are most important for this form.
MONTHLY WEIGHT RECORD AND MEDICATION QUESTIONAIRE FOR FOSTER CHILD
Date *
Date
CENTRALLY STORED MEDICATION *
All medications shall be stored in a safe place that is not accessible any unauthorized person. Is any prescription medication stored at your facility on behalf of the foster child?
MEDICATION DESTRUCTION *
Prescriptions medication not taken with the client upon termination of services shall be destroyed in the facility by the Administrator or Representative and witnessed by one other adult. Was any medication destroyed this month on behalf of the client?
PRESCRIPTION MEDICATION *
Are prescription medications being administered to the client this month?
PRN MEDICATION *
PN medications are over the counter medications that have been authorize in writing (usually during the CHDP exam) by a physician. Are PRN medications being administered to the client this month?