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# DLA Official Forms

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Form Information
| Form Number:       | DLA1849                                                                                                                                                                                                                               |
|--------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:        | Child and Youth Program (CYP) Medication Consent and Administration Log                                                                                                                                                               |
| Form Version:      | Aug 2019                                                                                                                                                                                                                              |
| Status:            | Active                                                                                                                                                                                                                                |
| Functional Area:   | Installation Management                                                                                                                                                                                                               |
| Opr:               | DM                                                                                                                                                                                                                                    |
| Safeguards:        | PAS, PII, OMB Collections                                                                                                                                                                                                             |
| Electronic:        | Yes                                                                                                                                                                                                                                   |
| Form Link:         | Documents/FormsSite/forms/DL1849.pdf                                                                                                                                                                                                  |
| Type:              | Primary                                                                                                                                                                                                                               |
| Prescribed:        | DLAI 1015.02                                                                                                                                                                                                                          |
| Description:       | This form will be used to authorize and track medication administration in a Child and Youth Program                                                                                                                                  |
| Records Retention: | Records Retention: 7304.1 Child Development Center. Temporary. Cutoff at end of Event. Maintain records as long as a child is enrolled. Upon termination from the program, forward records to Child Development Services Coordinator. |
| Form Audience:     |                                                                                                                                                                                                                                       |

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