CONSENT TO EXCHANGE MEDICATION

If a participant is feeling unwell or isolating due to infectious disease, an AABDS Support Worker can go into the community to purchase necessary supplies, including medication. Please ensure both the participant and the Support Worker complete the Consent to Exchange Medication form prior to this work being completed.

Consent to exchange medication form

The participant

I confirm that I have requested my AABDS Support Worker named below to pick up my medication and I have given them either a sum of money or my debit/credit card (as detailed below). I authorise this individual to purchase and deliver the items I have requested as I cannot currently leave my home. I understand that my Support Worker will provide me with all receipts and change/card from any purchases made on their return.

Particpant's full name

Support staff's full name

Date

If cash, I have given them the following amount:

Please list all medications to be picked up

Participant's/carers signature: I declare the above information is true and correct, I have received all medication requested and all receipts/change from the transaction.

Support Worker's signature: I declare the above information is true and correct.

Thanks for submitting!