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Authorization to Provide Medically Prescribed Treatment  Form

Authorization to Provide Medically Prescribed Treatment Form

Use a mcps form 525 13 template to make your document workflow more streamlined.

2019 Rockville Maryland 20850 Page 1 of 2 PART I TO BE COMPLETED BY THE PARENT/GUARDIAN I hereby request and authorize Montgomery County Public Schools MCPS and Montgomery County Department of Health and Human Services DHHS personnel to administer prescribed medication as directed by an authorized prescriber Part II below. I agree to release indemnify and hold harmless MCPS and DHHS and any of their officers staff members or agents from lawsuit claim demand or action against them for...
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