Injection Administration Record

Documents each injection exactly as it was given: product, dose, site, route, date and time, plus who administered it and under which licence. Safety checks and the next scheduled dose are logged on the same record.

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Patient full name

Nombre

Apellido

Date of birth

Gender

Female Male Non-binary Prefer not to say

Patient phone number

Administered by

Nombre

Apellido

Licence number or employee ID

Pre-administration checks

Patient identity verified Allergies reviewed Consent obtained Product expiry checked Dose verified Injection site inspected

Medication or injection name

Dosage (mL)

Badge number

Date of injection

Time of injection

Injection site

Route of administration

Next dose date

Staff signature

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