Medication Information Instructions

For the use of staff and volunteers supervising youth

Medical Information and Release Form and Over the Counter and Prescription Medication Summary (MIRF)

• Youth must have a Medical Information and Release Form and Over the Counter Prescription Medication Summary (MIRF) signed prior to participation in every 4‐H event.
• Staff and/or volunteers will be asked to submit these forms and the Code of Conduct at 4‐H events as they have in the past. Some events require submitting a second copy for off‐site activities or larger events. While other events, such as the Junior National Livestock Show, require forms to be uploaded in 4‐H Enrollment. See the Event Letters of district and state activities to determine how these forms are collected.
• The Over the Counter & Prescription Medication Summary should be copied on the back of the Medical Information and Release Form and is found as page 2 of the digital copy of the MIRF. Please make sure parents complete the form and check yes or no for each question listed. If all questions are not answered, this form is not complete. This, too, is valid for only one event, the event listed on the form.
• Youth may not be given any medication that is not indicated on the Over the Counter & Prescription Medication Summary unless the parent provides consent (over the phone) or medication is prescribed or administered by a trained medical professional.
• All forms should be retained in the Extension Office following the activity.

4‐H Medicine Form

• The Georgia 4‐H Medicine Form should be completed and submitted with any medication provided by parents/guardians to be given to a 4‐H’er.
• These medications should also be listed on the Over the Counter & Prescription Medication Summary (page 2 of the MIRF) for the event.
• Parents complete the information that pertains to medication including illness, description of medication, dates to be administered, and dosage. Staff and/or volunteers should maintain the medical log as medication is administered.
• This form is only valid during the activity or event listed on the form.
• The Medical Treatment Log should be used when administering any over the counter medications approved by the parent on the Over the Counter & Prescription Medication Summary and not listed on the 4‐H Medicine Form.
• All forms should be retained in the Extension Office following the activity