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Club J Authorization to Dispense Medication Childs Full Name: Name of Parent filling out form: Name of Medication: Dosage: Prescription Number: Time Medication is to be given: Amount of Medication to be given: Dates to be given: Parents - -

Club J Authorization to Dispense Medication Childs Full Name: Name of Parent filling out form: Name of Medication: Dosage: Prescription Number: Time Medication is to be given: Amount of Medication to be given: Dates to be given: Parents - - 2025

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4.3 out of 5

49 votes

The document is an authorization form for parents to permit Club J to dispense medication to their child. It includes sections for the child's name, parent's name, medication details (name, dosage, prescription number, timing, and duration), and a signature line for the parent. Additionally, there are sections for recording administration details and any adverse reactions observed.

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Versions	Form popularity	Fillable & printable
2022	4.6 Satisfied (52 Votes)
2009	4.3 Satisfied (49 Votes)

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