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Get and Sign Alabama State Department of Education Medication Form
Medication _____________________________________ Reason for Taking __________________________________
Dosage _______________ Route ________________________ Frequency/Time(s) to be given ____________________________
Begin Medication __________________________________ Stop Medication _________________________________________
Date
Date
Special Instructions:
Does medication require refrigeration? Yes □ No
□
Is the medication a controlled substance? Yes □ No
□
Is self-medication permitted and...
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