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MEDICATION ORDER FORM AUTHORIZATION FOR ADMINISTRATION OF MEDICATION AT SCHOOL STUDENT NAME: BIRTHDATE: SCHOOL: GRADE: THIS PORTION TO BE COMPLETED BY THE LICENSED HEALTH PROFESSIONAL (LAP×PRESCRIBING
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Nonprescription PRESCRIPTIVE LHPs BIRTHDATE LHP PRN Inhalers PRESCRIBING advisable specify timely inhaler furnished exceed labeled administered accordance administer doses manufacturer

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