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  • Authorization To Dispense Medication

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    jasong8476
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    Authorization to Dispense Medicine Name of Medication dosing time. I give permission for the Winton Road Youth Leaders to administer the above medication to my child.

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    Authorization to Dispense Medication

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    Authorization to Dispense Medicine Name of Medication dosing time. I give permission for the Winton Road Youth Leaders to administer the above medication to my child.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    5 views1 page

    Authorization To Dispense Medication

    Uploaded by

    jasong8476
    Authorization to Dispense Medicine Name of Medication dosing time. I give permission for the Winton Road Youth Leaders to administer the above medication to my child.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Authorization to Dispense Medicine

    Students Name: ____________________________________________ Age: __________

    Name of Medication

    Dose

    Time

    Reason

    Additional Notes/Comments:
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

    I give permission for the Winton Road Youth Leaders to administer the above medication to
    my child.

    _________________________________________________________
    (Signature)
    _________________________________________________________
    (Print Name)

    ________________
    (Date)

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