PetSmart Medication Form

PetSmart, Medication, Form

PetSmart

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File Info : application/pdf, 2 Pages, 304.52KB

Document Document

Pet's Name: Pet Parent (signature):

Medication Form
Last Name:

Date:

Is your pet allergic to any food (human or pet)? Yes No If yes, what?

Medication Name

For what condition/ailment is the pet being treated?
Is there any special way that you give your pet medication?

Verify type of medication ­

Ointment

count of prescription meds only Count:

Oral Count:

Verified medication as acceptable: Associate Initials:
Other - Specify: Count:

Is this medication to be administered regularly or on an "as needed" basis?

Regularly scheduled
As Needed

AM Amount:

Noon Amount:

PM Amount:

If you selected `As Needed" ­ specify the maximum daily dosage/frequency?

Medication Name

For what condition/ailment is the pet being treated?
Is there any special way that you give your pet medication?

Verify type of medication ­

Ointment

count of prescription meds only Count:

Is this medication to be administered regularly or on an "as needed" basis?

Regularly scheduled
As Needed

Verified medication as acceptable: Associate Initials:

Oral Count:

Other - Specify: Count:

AM Amount:

Noon Amount:

PM Amount:

If you selected `As Needed" ­ specify the maximum daily dosage/frequency?

Medication Name

For what condition/ailment is the pet being treated?
Is there any special way that you give your pet medication?

Verify type of medication ­

Ointment

count of prescription meds only Count:

Is this medication to be administered regularly or on an "as needed" basis?

Regularly scheduled
As Needed

Verified medication as acceptable: Associate Initials:

Oral Count:

Other - Specify: Count:

AM Amount:

Noon Amount:

PM Amount:

If you selected `As Needed" ­ specify the maximum daily dosage/frequency?

March 2021

PetSmart LLC Confidential

MEDICATION CALENDAR

To be completed by PetsHotel Leader or Lead. Indicate the check-in and check-out time in the "Notes" section below. Mark "NA" in each applicable time slot where the pet did not receive medication (at the scheduled time to be administered or assessed) due to check-in and/or check-out times. Include the exact time the medication was administered and the initials of the person administering it under AM/Noon/PM. Pets receiving medications "As Needed" must be evaluated at a minimum of three times daily (AM/Noon/PM) - confirm that the maximum daily dosage/frequency has not been exceeded prior to medicating.

Pet's Name:

Bin Number:

Room Number:

Check-In Date:

Check-Out Date:

Leader/Lead Initials:

Month Date

Med(s)

AM

Noon

PM

Notes

March 2021

PetSmart LLC Confidential