Graham Local School District Non-Prescription Medication Authorization Form All blanks must be completed

1. _______________________________________________________________________________________ Pupil’s name, complete address, and phone number

2. _______________________________________________________________________________________ Building and grade level of pupil

3. _______________________________________________________________________________________ Name of non-prescription medication and dosage to be administered

4. _______________________________________________________________________________________ List the time of day non-prescription medication is to be administered

5. _______________________________________________________________________________________ List the date the administration of the non-prescription medication is to begin

6. _______________________________________________________________________________________ List the date the administration of the medication is to cease

7. _______________________________________________________________________________________ _______________________________________________________________________________________ List all special instructions for the administration of the non-prescription medication including sterile conditions and storage

************************************************************ I, __________________________________, request that authorized personnel of Graham _________________ Name of Parent/Guardian

Building

administer the above medication to my son/daughter, ______________________________________, according Name of Pupil

to the written instructions. I further agree to relieve the Graham Local Board of Education and its employees of liability for administration of the non-prescription listed on this form.

_____________________________

___________________________________

Date

Non Presciption Form

Signature of Parent/Guardian

1 of 1

3/4/2002

Graham Local School District - Graham Local Schools

Mar 4, 2002 - Pupil's name, complete address, and phone number. 2. Building and grade level of pupil. 3. Name of non-prescription medication and dosage ...

12KB Sizes 2 Downloads 51 Views

Recommend Documents

Graham Local School District - Graham Local Schools
Mar 4, 2002 - I further agree to relieve the Graham Local Board of Education and its employees of liability for administration of the non-prescription listed on ...

logan-hocking local school district
Pumpkin Farm; Stuart's Opera House to see The Jungle Book and The Columbus Zoo and Aquarium. We also performed our 2nd ... Hamilton Twp. FAIR DAY.

2013-2016 Hanover Township Public Schools Local District ...
2013-2016 Hanover Township Public Schools Local District Technology Plan.pdf. 2013-2016 Hanover Township Public Schools Local District Technology Plan.

2013-2016 Hanover Township Public Schools Local District ...
Page 1 of 19. HANOVER TOWNSHIP PUBLIC SCHOOLS. 61 Highland Ave. Whippany, New Jersey 07981. Local District Technology Plan. July 1, 2013 – June 30, 2016. Submitted to meet the requirements of the. New Jersey Local Technology Plan. May 2013. Page 1

100 Addition - Highland Local Schools
3. 1. 5. 1. 5. 0. 3. 4. 2. 1. + 9. + 5. + 3. + 1. + 0. + 7. + 4. + 7. + 6. + 0. 2. 7. 6. 3. 6. 5. 1. 6. 8. 0. + 2. + 4. + 6. + 6. + 1. + 9. + 2. + 3. + 6. + 3. 6. 7. 5. 3. 4. 0. 4. 5. 1. 9. + 7.

[PDF] The Quiet American By Graham; Graham Greene ...
... business phone internet VoIP network and security solutions all in one place The most appropriate targets for systolic blood pressure to reduce cardiovascular ...

Read PDF The Quiet American By Graham; Graham ...
... Quiet American By Graham Greene Summary Study Guide Epub Download Related Book Ebook Pdf The Quiet American By Graham Greene Summary Study ...

[PDF Download] Graham Best EPUB Book By Graham ...
Download Best Book Graham, PDF Download Graham Free Collection, PDF Download Graham Full Online, epub free Graham, ebook free Graham, free ebook ...

Precipitation in Ohio - Cloverleaf Local Schools
hot, too dry, too cold, or too wet. The past several years are vivid examples ... ODNR Publications Center ($6.54 if ordered by mail). Average Annual Precipitation.

Precipitation in Ohio - Cloverleaf Local Schools
Basic Data for Water Projects. The Division of ... Service and to a lesser extent, by other state and federal agencies. ... Columbus, Ohio 43229-6693. Voice: (614) ...

AMA Graham Cassidy.pdf
1 day ago - the individual insurance market; ensure that low- and moderate-income patients are able to secure. affordable and meaningful coverage; and ...

Pat Graham Notes.pdf
Whoops! There was a problem loading more pages. Retrying... Pat Graham Notes.pdf. Pat Graham Notes.pdf. Open. Extract. Open with. Sign In. Main menu.

Fluoropolymer medical tubing - Graham Engineering
Jan 25, 2017 - For small medical extruders, 1.25-inch (32 ... breakage when using an Inconel or Hastelloy screw while processing other high temperature.

Graham 1850.pdf
... iron at the negative plate may become. protoxide, while its oxygen is engaged in forming a polar molecule. with the platinum. But the intensity of polarization with the salts. * Mr. A. R. Arnott, on "Some New Cases of Voltaic Action;" Memoirs of

AMA Graham Cassidy.pdf
5 hours ago - Program (CHIP), and other safety-net programs are adequately funded. ... reductions, small business tax credit, and Medicaid expansion, and ... not have access to coverage for services pertinent to treating their conditions.

Graham - short bio.pdf
THE NORTHERN TERRITORY HAS ENJOYED POLICE PROTECT]ON ... CONSTABLES LANDED IN PALMERSTON (NOW DARWIN) FROM SOUTH ...

Graham 1854.pdf
capillarity. But these last forces act on masses and not on molecules, and the ultimate. particles of water and salt which alone diffuse, appear really to permeate ...

pdf-0947\se-graham-2in1-angles-peace-with-god-by-billy-graham ...
pdf-0947\se-graham-2in1-angles-peace-with-god-by-billy-graham.pdf. pdf-0947\se-graham-2in1-angles-peace-with-god-by-billy-graham.pdf. Open. Extract.

1 to 1 Device Parent Responsibilities - North Union Local Schools
I will supervise my child's use of the Internet and email. ... turned over to the Union County Prosecutor' office and/or the student's parent/guardian will be billed for ...

1 to 1 Device Parent Responsibilities - North Union Local Schools
North Union Local Schools. 1:1 Device Parent Responsibilities. Your son/daughter has been issued a portable device to improve and personalize his/her ...

Flawless by Heather Graham
store in the middle of a heist. She's there to ... or bookshelves' grow to be full because you can have it inside your lovely laptop even cell phone. This Flawless ...

Lynne Graham - Pasión italiana.pdf
Con lo que no contaba era con que la. dulzura de Holly, y al mismo tiempo la indiferencia. que le provocaba su riqueza, fueran a conmover. tanto su corazón.

Mathematics-Graham-Knuth-Patashnik-_Concrete.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Main menu.

Solomons, Graham - Fundamentals Of Organic Chemistry.pdf ...
COURSE CHEM 220A AT YALE UNIVERSITY. The students ... They are a superb group of people who did exceptionally well in ... Partial List as of April 20, 2001.