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The covenants and undertakings of this Release are given for and shall be binding upon me and the Minor s family heirs estate next of kin executors administrators legal representatives beneficiaries successors and assigns. Signature of Health Care Provider with Prescriptive Authority Phone Number Printed name of Health Care Provider with Prescriptive Authority This form complies with regulations of the State of Colorado for medication administration.. The High Trails nurse will assess a need...
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