Clinical Reference Systems: Pediatric Advisor 10.0
Medications Needed at School or Day Care
Child's name ____________________________________________________
Diagnosis _______________________________________________________
Medication name _________________________________________________
Dosage __________________________________________________________
When to give medication at school or day care:
_________________________________________________________________
_________________________________________________________________
Thank you. Please call if you have any questions.
Physician's name ________________________________________________
Physician's signature _________________________ Date ____________
Physician's phone number _________________________________
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