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The medication will be furnished to Usdan in a properly labeled original pharmacy container. I understand that a Usdan Center nurse will administer the medication. SIGNATURE parent or guardian DATE ADDRESS TELEPHONE home work NAME OF STUDENT DATE OF BIRTH DIAGNOSIS NAME OF MEDICATION PRESCRIBED DOSAGE FREQUENCY AND ROUTE OF ADMINISTRATION TIME TO BE TAKEN DURING CAMP HOURS DURATION OF TREATMENT POSSIBLE SIDE EFFECTS AND ADVERSE REACTIONS IF ANY OTHER RECOMMENDATIONS NAME AND TITLE OF LICENSED...
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