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**** PLEASE CHECK ALL MEDICATIONS WHICH ARE AUTHORIZED TO BE GIVEN **** 2 tabs BY MOUTH every 4 hours AS NEEDED, for pain and or fever not to exceed 8 tabs in a 24-hour period For relief of minor sunburn symptoms. Apply sparingly to affected parts AS 2 tabs BY MOUTH every 2 hours for heartburn and indigestion, not to exceed 24 tabs in 24 hours For scratches and surface abrasions. Apply topically 2x day as needed. Use for 7 days only. Apply 2x a day to clean, dry feet / fungal infection AS NEEDED. Stop after 30 days. Apply with swab to area in the mouth. Use for only 7 days. DO NOT USE IF ALLERGIC TO LOCAL ANESTHETICS Apply to skin irritations, hives, or rashes TOPICALLY 3 times a day as needed. For treatment of acne. Apply to affected area on clean dry face 2 x day for 30 days then reassess. Keep away from eye.
Relieves the pain of minor burns, sunburn, scalds, and abrasions TOPICALLY as needed 2x day Apply TOPICALLY to dry, oozing, weeping poison ivy, poison oak, and poison sumac 2 x day as needed. Do not use for more than 7 days. Gently massage into the affected and surrounding areas2x a day for candidiasis For fungal infection of skin and feet (athlete’s feet). Apply to clean dry affected areas and surrounding skin twice a day for 3-4 weeks. he relief of minor cough/throat irritation. 1 drop BY MOUTH every 2 hours, not For thto exceed 6 in 24 hours. For the relief of runny nose, itchy eyes/skin, or other allergy symptoms. 1 tab BY MOUTH every 4 hours, as needed not to exceed 6 tabs in a 24-hour period For the relief of non-chronic coughs. 2 tsps (10cc) BY MOUTH every 4 hours as needed not to exceed 12 tsps in 24 hours. For itching associated with insect bites, surface abrasions, poison ivy, etc. Apply 2-3 times daily. As needed TOPICALLY For pain /FEVER/MENSTRAL CRAMPS 2 tab BY MOUTH every 6 hours, as needed not to exceed 8 tabs in a 24-hour period 1 tablespoon (15 cc) BY MOUTH as needed after each loose bowel movement. Not to exceed 4 doses in 24 hours. Stop after 7 days. Temporary relief of symptoms due to upper respiratory allergies: runny nose, itchy, watery eyes, sneezing, itching of nose and throat. 1 tab BY MOUTH daily, not more than 1 tablet in 24 hours. 1 tablespoon (15 CC) BY MOUTH every 4 HRS - AS NEEDED for gas pains or indigestion. Not to exceed 6 doses in 24 hours. Stop after 30 days. 2 caplets BY MOUTH every 6 hours AS NEEDED FOR MENSTRUAL CRAMPS not to exceed 4 doses in 24 hours 2- Tablespoons (30 cc) by mouth at bedtime followed by 8 oz water for constipation. Stop after 7 days. DO NOT GIVE WHEN ABDOMINAL PAIN,

Topical treatment for relief of muscle ache. Massage affected area 3 x daily as needed. Use for 3 days only. b by mouth as needed every 12 hours pain/menstrual cramps 1 tabDo not exceed 2 tabs in a 24-hour period Thoroughly massage into skin from the head to the soles of the feet for the treatment of infestation of scabies. Shower after 8-14 hours. May retreat P.R.N. 1 tab by mouth as needed every 12 hours for sinus congestion DO NOT exceed 2 tabs in a 24 hours For dry nasal membranes or congestion. Squeeze 2 times each nostril, twice a To prevent sunburn apply liberally to all exposed parts. As needed 3xday IMPORTANT: YOU MUST COMPLETE AND SIGN THIS FORM


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