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Sachem Central School District APPENDIX D SELF-MEDICATION RELEASE FORM Date: Child s Name: Has been instructed in the proper use of the following medication procedures: We, (Physician s signature)
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Self medication form is a document that allows individuals to record and track their own medication usage without a prescription.
Anyone who is self-medicating or managing their own medication regimen is required to file a self medication form.
To fill out a self medication form, individuals should include details such as medication name, dosage, frequency of use, and any side effects experienced.
The purpose of a self medication form is to help individuals keep track of their medication usage and communicate important information to healthcare providers.
Information such as medication name, dosage, frequency of use, side effects, and any interactions with other medications must be reported on a self medication form.
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