Safe Hands - Newcastle, NSW

Medication Authority

This form authorises Safe Hands workers to support the named participant with the medications listed below. Must be completed and signed by the prescribing health professional. A separate Medication Authority is required when medications change. Refer to Medication Management Policy (POL-MED-001).

Form IDFORM-MA-001

Version1.0

Effective1 January 2026

Linked PolicyPOL-MED-001

1. Participant Details

Participant full name

Date of birth

NDIS participant number

Address (delivery location)

Known allergies and contraindications

2. Medications Authorised

List each medication separately. Use additional sheets if more than 4 medications.

Medication name & strength	Dose	Route	Frequency / timing	Purpose / indication

3. Administration Method for Support Workers

Tick all that apply. Workers may only act within the specifically authorised methods.

Authorised method(s)

☐ Prompting only (participant self-administers)
☐ Assisting (e.g. opening blister pack, handing the medication)
☐ Administering oral medication
☐ Administering topical creams / ointments
☐ Administering eye / ear drops
☐ Administering nebuliser
☐ Administering injection (specify type)
☐ Other (specify):

Storage requirements

Known side effects to monitor for

What to do if a dose is missed or refused

4. PRN (As-Needed) Medications

For any PRN medications listed above, specify exactly when the worker may administer.

PRN indications and limits

5. Prescribing Health Professional

Name

Role

GP / Specialist / Pharmacist

Practice / clinic

Phone

AHPRA registration number

Date signed

Authority valid until: Specify a review date (commonly 6 or 12 months from date of signing) or when medications change.

Review date

Practitioner signature

6. Participant / Representative Consent

The participant (or authorised representative if the participant cannot consent themselves) must agree to Safe Hands supporting medication administration.

Participant / Representative name

Print / Signature

Relationship to participant (if rep)

Date

7. Safe Hands Receipt

Received by (Safe Hands Manager)

Name / Date

Authority recorded in participant file

Initials / Date