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Get VA Written Medication Consent Form

Ltiple medications cannot be listed on one consent form. Parents MUST complete #1 through #23 (omit #18) for medication to be administered 10 days or less OR for non-prescription topical medication including sunscreen, diaper ointment or insect repellent. The child’s health care provider MUST complete #1 through #18 for Long-Term medications or when dosage directions state “consult a physician.” The parent completes #19 through #23. 1. Child’s first and last name: 2. Date of birth: 4..

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