Maryland child care providers may only give a child prescription or over-the-counter medication when this form is completed fully. The prescriber writes the order, the parent consents and confirms a first dose was given at home without problems, and staff log every dose on the second page. Asthma, allergy and seizure medicines use OCC 1216A, 1216B and 1216C instead.
The prescriber completes the Prescriber's Authorization and signs it. The parent or guardian completes the authorization section, and child care staff complete the staff checklist and the administration log.
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Medication Administration Authorization Form
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Yes. The form is required for both prescription and non-prescription medications. Prescription medication must be in a container labeled by the pharmacist or prescriber, and over-the-counter medication must be in the original container with the label intact.
The authorization may not exceed one year. The prescriber enters the dates the medication is to be given, and at the end of the authorized period an authorized individual must pick up the medication or it will be discarded.
Maryland has separate forms for asthma medication (OCC 1216A, an asthma action plan), allergy and anaphylaxis medication (OCC 1216B) and seizure medication (OCC 1216C). Each states it replaces or is used without OCC 1216 for that medication.