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    Weyver

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    roulette layp
    This document is a parent/guardian waiver form for Bonoan Health Support Services at Ateneo de Naga University. It lists various over-the-counter medications that health personnel may administer to students if deemed necessary. The parent/guardian signs to consent to their child receiving first aid and the listed medications, and releases the health personnel from liability for any adverse drug reactions. Space is provided to note any known allergies or contraindications to the medications.

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    Weyver

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    roulette layp
    53 views1 page
    This document is a parent/guardian waiver form for Bonoan Health Support Services at Ateneo de Naga University. It lists various over-the-counter medications that health personnel may administer to students if deemed necessary. The parent/guardian signs to consent to their child receiving first aid and the listed medications, and releases the health personnel from liability for any adverse drug reactions. Space is provided to note any known allergies or contraindications to the medications.

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    This document is a parent/guardian waiver form for Bonoan Health Support Services at Ateneo de Naga University. It lists various over-the-counter medications that health personnel may administer to students if deemed necessary. The parent/guardian signs to consent to their child receiving first aid and the listed medications, and releases the health personnel from liability for any adverse drug reactions. Space is provided to note any known allergies or contraindications to the medications.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    53 views1 page

    Weyver

    Uploaded by

    roulette layp
    This document is a parent/guardian waiver form for Bonoan Health Support Services at Ateneo de Naga University. It lists various over-the-counter medications that health personnel may administer to students if deemed necessary. The parent/guardian signs to consent to their child receiving first aid and the listed medications, and releases the health personnel from liability for any adverse drug reactions. Space is provided to note any known allergies or contraindications to the medications.

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    © All Rights Reserved
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    BONOAN HEALTH SUPPORT SERVICES

    ATENEO DE NAGA UNIVERSITY


    Fr. Bonoan SJ Campus, Fr. Phelan SJ Drive, Km-7, Pacol, Naga City

    PARENT’S OR GUARDIAN ‘S WAIVER


    This is to certify that I, __________________________________________ parent/guardian of
    ________________________________________(name of student), is giving my permission to the
    health personnel to assess my child and to administer first-aid and medications as listed below. This is
    when deemed necessary and appropriate to his/her condition. I further understand that I am releasing
    the health personnel, who administer the drug to my child, from any liability due to adverse drug
    reaction.

     Tempra (Paracetamol)  Terramycin (Ophthalmic


     Dolan (Ibuprofen) Ointment)
     Glucolyte (Oral Rehydration Salt)  Bactroban (antibiotic)
     Relestal (antispasmodic)  Flammazine (antibacterial)
     Buscopan  Betnovate (Steroidal Anti-
     Decolgen (no drowse) inflammatory/ Antipruritic)
     Neozep (no drowse)  Salbutamol nebule
     Disudrin  Combivent nebule
     Asmalin/ Ventolin (Salbutamol)  Bonamine
     Mefenamic acid  Simeco
     Carbocisteine (Solmux)  Loperamide ( Diatabs)
     Ambroxol  Omeprazole
     Allerzet/ Celestamine (anti-  Visine
    histamine)  Strepsils
     Cetirizine (Zyrtec)  White Flower
     Loratadine (Allerta)  Calmoseptine (anti-itch)
     Hydrogen Peroxide  Omega Pain Killer
     Povidone Iodine gargle solution  Vicks
     Betadine  Aceite de Manzanilla
     Eurax (anti-itch)

    Please indicate if your child/ ward has an allergy or contra-indication from the
    above mentioned medicines. _________________________________________________________

    Or

    □ I do not want my child/ ward to be given with any school medicines in any case
    or situation.
    __________________________________________________ _________________
    Parent/ Guardian Signature above Printed Name Date

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