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Please list any known allergies Name of Medication Benadryl Tums Ibuprofen cramps headache discomfort Tylenol fever headache discomfort Midol menstrual cramps Please Circle yes no Dosage. Visitation Academy Live Jesus 2016-2017 PHYSICIAN/PARENT OR GUARDIAN MEDICATION CONSENT FORM Date Student Parent s Name Grade Date of Birth Home Phone Mom s Cell Phone Dad s Cell Phone Mom s Work Phone Dad s Work Phone CONSENT FOR ADMINISTRATION OF PRESCRIPTION MEDICATION Medication Dose Time Interval...
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