Free Pediatric Medication List Template

Pediatric Medication List

This Pediatric Medication List is intended for medical management purposes and has been compiled by [YOUR NAME]. It provides essential details about prescribed medications for the child listed below.


Patient Name: Jody Lusk

  • Date of Birth: January 15, 2055

  • Medical Record Number: 314-8400-371

  • Date Compiled: July 3, 2060

Medication Details

Medication Name

Dosage

Frequency

Route

Special Instructions

Amoxicillin

250 mg

Twice daily

Oral

Take with food.

Ventolin (Albuterol)

2 puffs

Every 4-6 hours as needed

Inhalation

Use spacer device.

Prednisolone

5 mg

Once daily

Oral

Take in the morning.

Zyrtec (Cetirizine)

5 mg

Once daily

Oral

Take at bedtime.

Epinephrine (EpiPen)

0.3 mg

As needed for emergencies

Intramuscular

Administer in case of allergic emergency.

Fluticasone (Flonase)

1 spray

Once daily

Nasal

Shake well before use.

Acetaminophen (Tylenol)

160 mg

Every 4-6 hours as needed

Oral

Do not exceed 5 doses in 24 hours.

Ibuprofen (Advil)

100 mg

Every 6-8 hours as needed

Oral

Take with food.

Miralax (Polyethylene glycol)

17 g

Once daily

Oral

Mix with water or juice.

Ranitidine (Zantac)

2.5 mL

Twice daily

Oral

Take on an empty stomach.

Reminders:

  • Ensure medications are stored out of reach of children.

  • Follow prescribed dosages and timings strictly.

  • Contact [YOUR NAME] at [YOUR COMPANY NUMBER] for any medication-related queries.

  • Keep this list updated with any changes in the child's medication regimen.

  • Emergency responders should be informed of this list in case of emergencies.


Created By: [YOUR NAME]

  • Email Address: [YOUR EMAIL]

  • Company Name: [YOUR COMPANY NAME]

  • Address: [YOUR COMPANY ADDRESS]

  • Website: [YOUR COMPANY WEBSITE]

  • Social Media: [YOUR COMPANY SOCIAL MEDIA]

This Pediatric Medication List is a vital tool for managing the child's medications effectively.

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