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ALTONA GREEN PRIMARY SCHOOL MEDICATION REQUEST FORM Please Note School staff do not monitor the effects of medication and will seek emergency medical assistance if concerned about a student s behaviour following medication. CHILDS NAME GRADE EMERGENCY TELEPHONE I request that my child be administered the following medication whilst at school. NAME OF MEDICATION DOSAGE Amount TIME/S TO BE TAKEN DOES THIS MEDICATION NEED TO BE STORED IN THE FRIDGE YES / NO OTHER INFORMATION I have sent the...

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