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FOR VIEWING PURPOSES ONLY Pinellas County Schools SCHOOL HEALTH SERVICES AUTHORIZATION FOR ADMINISTRATION OF EMERGENCY MEDICATION (EX:DISTANT, CLONAZEPAM WAFER, EPI PEN, GLUCAGON) Student Name: Date:
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GLUCAGON PCS SHS DIASTAT CLONAZEPAM Pinellas Recieved Clonazapam ie WAFER injector herein prescribing VERIFICATION expiration cancellation physicians labeled medically medications administer instruct disposed

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