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Nonprescription medication must be in the original container with the instructions for use. Nonprescription medication includes vitamins homeopathic and herbal medicines. State/territory in which child resides 2. Is this child exempt from any immunizations YES List them DHMH-4768 1/15 OR 1. Date Authorized Signature Parent Name of Soldier s Cellphone Additional phone number E-mail address Emergency Contact Name MEDICATION ADMINISTRATION AUTHORIZATION FORM Department of Health Mental Hygiene...
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