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Permission to Administer Prescription/OTC Medication

Please complete the form below. Required fields marked with an asterisk *
Is this a rescue medication?*
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If it is a rescue medication, please upload the plan of care from your prescribing physician.
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or drag it here.

* It is hereby understood by the undersigned that school personnel are not held liable for the administration of the above medication or for its possible side effects.

** Medication is to be brought in its original pharmacy container. Duplicate containers can usually be obtained from the pharmacist for home storage if needed. For safety and security reasons, it is mandatory that all medications be brought to school by the parent/guardian, and not sent in with the child. If the medication is sent in with the child it will not be administered.

I understand and agree*
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