Asthma Medication Administration Record

About the Asthma Medication Administration Record

A digital asthma medication administration record designed to comply with Regulations 90, 92, and 93 of the Education and Care Services National Regulations. This form captures asthma signs and symptoms observed, Ventolin administration details including dosage, spacer use, and expiry date, witness verification, and a multi-step signing workflow with responsible person review and parent acknowledgement including previous administration details.

Also called

  • Asthma medication record
  • Asthma medication administration form
  • Asthma MAF

What's on this form

Every question included in the asthma medication administration record. Add, remove or reword any of them in the form builder.

Step 1 — Completed first

Filled in by the educator or responsible person

  • Child

    Child details

  • Asthma Signs And Symptoms

  • Date Signs And Symptoms Presented

    Date

  • Time Signs And Symptoms Presented

    Time

  • Session Type

    • Before School Care
    • After School Care
    • Vacation Care

    Choose one

  • Signs And Symptoms Observed or Described

    • Coughing
    • Wheezing
    • Tightness of Chest
    • Difficulty Breathing

    Choose any

  • First Educator On Scene

    Short answer

  • Description or Comments

    Long answer

  • Administration Details

  • Time of Administration

    Time

  • Who's Ventolin Inhaler Was Used?

    Short answer

  • Ventolin Expiry Date

    Date

  • Spacer Used? (Allows higher dosage of Ventolin)

    Yes / No

  • Puffs Delivered (child will sit up straight, shake puffer)

    Short answer

  • Who Administered?

    Short answer

  • Person who witnessed administration and checked dosage was correct

    Educator signature

  • Notification Notes

  • Person Completing Form

    Educator signature

Step 2 — Responsible Person

Completed by a staff member at the service

  • Responsible Person Details

    Educator signature

Step 3 — Parent / Guardian

Sent to the parent or guardian to sign

  • Medication Last Administered

  • Date Of Previous Administration

    Date

  • Time Of Previous Administration

    Time

  • Parent/Guardian Signature

    Signature

How this form gets signed

This template runs as a multi-step signing workflow. Each person is notified in turn, and every signature is timestamped and stored against the record.

  1. 1

    Responsible Person

    Signs inside the service, using a staff PIN

  2. 2

    Parent/Guardian

    Signs externally — receives a secure link by email, no account needed

Australian regulations this form supports

The asthma medication administration record is built around the Education and Care Services National Regulations. These are the regulations it helps you meet.

Reg 90

Medical conditions policy

Services must have a medical conditions policy covering asthma management. Parents must provide a medical management plan that must be followed during incidents.

Read the full text of Reg 90

(1) The medical conditions policy of the education and care service must set out practices in relation to the following— (a) the management of medical conditions, including asthma, diabetes or a diagnosis that a child is at risk of anaphylaxis; (b) informing nominated supervisors and staff members of, and volunteers at, the service of practices in relation to managing those medical conditions; (c) the requirements arising if a child enrolled at the education and care service has a specific health care need, allergy or relevant medical condition, including— (i) requiring a parent of the child to provide a medical management plan for the child; and (ii) requiring the medical management plan to be followed in the event of an incident relating to the child's specific health care need, allergy or relevant medical condition; and (iii) requiring the development of a risk-minimisation plan in consultation with the parents of a child— (A) to ensure that the risks relating to the child's specific health care need, allergy or relevant medical condition are assessed and minimised; and (B) if relevant, to ensure that practices and procedures in relation to the safe handling, preparation, consumption and service of food are developed and implemented; and (C) if relevant, to ensure that practices and procedures to ensure that the parents are notified of any known allergens that pose a risk to a child and strategies for minimising the risk are developed and implemented; and (D) to ensure that practices and procedures ensuring that all staff members and volunteers can identify the child, the child's medical management plan and the location of the child's medication are developed and implemented; and (E) if relevant, to ensure that practices and procedures ensuring that the child does not attend the service without medication prescribed by the child's medical practitioner in relation to the child's specific health care need, allergy or relevant medical condition are developed and implemented; and (iv) requiring the development of a communications plan to ensure that— (A) relevant staff members and volunteers are informed about the medical conditions policy and the medical management plan and risk minimisation plan for the child; and (B) a child's parent can communicate any changes to the medical management plan and risk minimisation plan for the child, setting out how that communication can occur. (2) The medical conditions policy of the education and care service must set out practices in relation to self-administration of medication by children over preschool age if the service permits that self-administration. (3) In subregulation (2), the practices must include any practices relating to recording in the medication record for a child of notifications from the child that medication has been self-administered.

Reg 92

Medication record

A medication record must include the child's name, authorisation, medication name, dosage, time administered, and signature of the person who administered it.

Read the full text of Reg 92

(1) The approved provider of an education and care service must ensure that a medication record is kept that includes the details set out in subregulation (3) for each child to whom medication is or is to be administered by the service. (2) A family day care educator must keep a medication record that includes the details set out in subregulation (3) for each child being educated and cared for by the educator as part of a family day care service to whom medication is or is to be administered. (3) The details to be recorded are— (a) the name of the child; (b) the authorisation to administer medication (including, if applicable, self-administration), signed by a parent or a person named in the child's enrolment record as authorised to consent to administration of medication; (c) the name of the medication to be administered; (d) the time and date the medication was last administered; (e) the time and date, or the circumstances under which, the medication should be next administered; (f) the dosage of the medication to be administered; (g) the manner in which the medication is to be administered; (h) if the medication is administered to the child— (i) the dosage that was administered; and (ii) the manner in which the medication was administered; and (iii) the time and date the medication was administered; and (iv) the name and signature of the person who administered the medication; and (v) if another person is required under regulation 95 to check the dosage and administration, the name and signature of that person.

Reg 93

Administration of medication

Medication must not be administered unless authorised and administered in accordance with regulations. Written notice must be given to parents.

Read the full text of Reg 93

(1) The approved provider of an education and care service must ensure that medication is not administered to a child being educated and cared for by the service unless— (a) that administration is authorised; and (b) the medication is administered in accordance with regulation 95 or 96. (2) The approved provider of an education and care service must ensure that written notice is given to a parent or other family member of a child as soon as practicable, if medication is administered to the child under an authorisation referred to in subregulation (5)(b). (3) A nominated supervisor of an education and care service must ensure that medication is not administered to a child being educated and cared for by the service unless— (a) that administration is authorised; and (b) the medication is administered in accordance with regulation 95 or 96. (4) A family day care educator must ensure that medication is not administered to a child being educated and cared for by the educator as part of a family day care service unless— (a) that administration is authorised; and (b) the medication is administered in accordance with regulation 95 or 96. (5) In this regulation the administration of medication to a child is authorised if an authorisation to administer the medication— (a) is recorded in the medication record for that child under regulation 92; or (b) in the case of an emergency, is given verbally by— (i) a parent or a person named in the child's enrolment record as authorised to consent to administration of medication; or (ii) if a parent or person named in the enrolment record cannot reasonably be contacted in the circumstances, a registered medical practitioner or an emergency service.

Provided for information only and may not reflect the latest amendments. Refer to the Education and Care Services National Regulations (NSW) for the official legal text.

Where this form fits

The asthma medication administration record is part of these jobs — each guide walks through the whole sequence and the other forms that go with it.

Questions about the asthma medication administration record

What is the asthma medication administration record used for?

A digital asthma medication administration record designed to comply with Regulations 90, 92, and 93 of the Education and Care Services National Regulations. This form captures asthma signs and symptoms observed, Ventolin administration details including dosage, spacer use, and expiry date, witness verification, and a multi-step signing workflow with responsible person review and parent acknowledgement including previous administration details.

Who fills in the asthma medication administration record?

The asthma medication administration record is completed by educators or the responsible person at the service. Staff open it on any device and sign with a service PIN, so there's no separate login to manage. It then moves through 2 signing steps — Responsible Person and Parent/Guardian — with each signature timestamped against the record.

Which Australian regulations does the asthma medication administration record meet?

It is built around Reg 90, Reg 92 and Reg 93 of the Education and Care Services National Regulations. Reg 90 covers medical conditions policy. Reg 92 covers medication record. Reg 93 covers administration of medication. Every question the regulations require is already on the form.

Is the asthma medication administration record the same as an asthma medication record?

Yes. Different services use different names for this form — it is also called asthma medication record, asthma medication administration form and asthma maf. They all describe the same record, and this template covers it. You can rename it to whatever your service already calls it.

Can I change the questions on the asthma medication administration record?

Yes. The template comes with 23 fields ready to go, but you can add, remove, reword or reorder anything in the drag-and-drop form builder, and add your own conditional logic and signing steps. Your changes only affect your service's copy.

Is the asthma medication administration record free?

Yes — the asthma medication administration record is free to use on the Childcare Forms free plan. No credit card is required to create an account and start sending it.

Ready to use it?

Create a free account, change anything you want, and send it to your first family. No credit card needed.