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Page 1 of 2. COLOMA OUTDOOR DISCOVERY SCHOOL. Student Medical Information and Release Form. If necessary, should first aid be given? Yes ______ ...

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Page 1 of 2. DIAGNOSIS: REASON MEDICATION MUST BE GIVEN IN SCHOOL: NAME OF MEDICATION/EQUIPMENT/TREATMENT: THE SCHOOL DISTRICT OF PHILADELPHIA. SCHOOL HEALTH SERVICES. REQUEST FOR ADMINISTRATION OF MEDICATION, TREATMENTS OR USE OF EQUIPMENT IN SCHOOL