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Get Fairfax County Epinephrine Authorization Form

Click here to reset the student specific fields on this form. Parent or Guardian information will not be affected by this RESET function. EPINEPHRINE AUTHORIZATION PLEASE READ INFORMATION AND PROCEDURES ON REVERSE SIDE PART I PARENT OR GUARDIAN TO COMPLETE I hereby authorize Fairfax County Public Schools FCPS Fairfax County Health Department FCHD and School Age Child Care SACC personnel to administer epinephrine injection s as directed by the phy.

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