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Name: Grade×Teacher Date: LOWER MERION SCHOOL DISTRICT Request from Parents & Physicians to have Emergency Medication Administered in School Diagnosis: Name of Medication: Date Prescribed: Dosage

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1. Start by downloading the ermedicineformdoc from a reliable source or obtaining it from the designated healthcare provider in Gladwyne.
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4. Begin by accurately entering your personal information into the designated fields. This may include your full name, date of birth, gender, and contact information.
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8. If there are sections for emergency contact information or your primary care physician's details, provide the required information accurately. This is important for communication and coordination among healthcare providers.
9. Review the completed form for any errors or missing information. Double-check all the provided details to ensure accuracy and completeness.
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