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This information will be handled in a confidential manner. Authorization is good for one school year only. Student School Date of birth or age Date form received by the school Grade self-possession Administrator approval for self-administration To be completed by the physician or authorized prescriber Name of medication Reason for medication OPTIONAL Tablet/capsule Liquid Inhaler Injection Form of medication/treatment Nebulizer Other Instructions schedule and dose to be given at school date...

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West Bloomfield School is a public school district located in West Bloomfield, Michigan.

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