Medication Log Training

Step-by-step walkthrough of the Assuring Love Medication Log, using a sample child for June 2025.

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Assuring Love Medication Log

Child's Name:

DOB:

Page: of

Allergies:

Family Name:

Month/Year:

Page 1

Assuring Love Medication Log

Child's Name:

DOB:

Page: of

Allergies:

Family Name:

Month/Year:

PRN Medications and Refusal/Omission:

	Date/Time	Medication and Strength	Reason and Result	Signature
1.
2.
3.
4.
5.

Medication Changes:

	Date of Change	Medication and Strength	Type of Change (Dosage Change; New Medication; Discontinued Medication)	Date of Notification (Must notify DFPS and Assuring Love within 24 hours)
1.
2.
3.
4.
5.

Printed Name
Signature and Initials
Printed Name
Signature and Initials
Assuring Love Review

Page 2

Step 1

Voice Speed Mute

Press Play to start. Your browser reads each step out loud, so turn your sound on. Chrome and Edge have the clearest voices. On a phone, turn it sideways for a bigger view of the form.