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Authorization to Administer Medication - Child Care ...

DEPARTMENT OF CHILDREN AND FAMILIES Division of Early Care and Education DCF-F-CFS0059 (R. 04/2020) i Authorization TO Administer Medication Child CARE CENTERS INSTRUCTIONS FOR USE Use of form: This form is mandatory for licensed family Child care centers to comply with DCF (6)(f) Failure to comply may result in issuance of a noncompliance statement. This form is voluntary for group Child care centers, day camps, and certified providers; however, completion of this form meets the requirements of DCF (6)(f) , DCF (6)(e) , and DCF (4)(f) Wis. Admin. Codes. Personal information you provide may be used for secondary purposes [Privacy Law, (1)(m), Wisconsin Statutes].

Page 1 Medication Information and Authorizationis voluntary for group child care centers and day camps; however, completion of this form meets the requirements of DCF 251.07(6)(f)1.a. and DCF 252.44(6)(e)1.a., Wis. Admin. Codes. Have the child’s parent or guardian complete and sign Page 1 Medication Information and Authorization . Page 2

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