Medication Administration Log *=required Cadet Applicant Name First Name* Middle Name Last Name* Medication Information Medication 1 Medication Name or "NONE"* Dose Pill Color / Description Administration AM (All Daily Meds's) YesNo Afternoon YesNo PM YesNo Special instructions if required Medication 2 Medication Name Dose Pill Color / Description Administration AM (All Daily Meds's) YesNo Afternoon YesNo PM YesNo Special instructions if required Medication 3 Medication Name Dose Pill Color / Description Administration AM (All Daily Meds's) YesNo Afternoon YesNo PM YesNo Special instructions if required If more room is needed for medications, please check the box below, submit form and fill out the form again with the additional medications. Additional medications Parent / Guardian Name* Parent / Guardian E-mail*
