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DPHHS-QAD/CCL-120 (Revision 06-07) NON-INGESTIBLE OVER THE COUNTER (OTC) MEDICATION AUTHORIZATION FORM TO BE COMPLETED BY PARENT Child s Name Date of Birth / / Program Name Today s Date / / *************************************************************************************************.

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How to fill out the Non Ingestible Form online

Filling out the Non Ingestible Form for over-the-counter medications is a crucial step for parents to ensure proper care for their children. This guide will help you navigate the form with clear instructions for each section to make the process straightforward and efficient.

Follow the steps to complete the Non Ingestible Form online.

  1. Press the ‘Get Form’ button to access the Non Ingestible Form and open it in your digital editor.
  2. Enter the child's name in the designated field along with the date of birth.
  3. Fill in the program name where your child is enrolled and include today’s date.
  4. Carefully review the list of non-ingestible over-the-counter medications and mark all that apply to grant permission for their administration.
  5. If applicable, specify any other non-ingestible OTC medications in the provided space.
  6. Provide any special handling or storage instructions, and indicate whether refrigeration is necessary.
  7. Sign the form as the parent or guardian to confirm permission for the administration of the selected medications.
  8. Complete the unused medication section as needed and note whether it will be returned to you or discarded.
  9. Once all fields are accurately filled, you can save your changes, download a copy for your records, print the form, or share it as necessary.

Complete your Non Ingestible Form online today to ensure your child's wellness needs are met.

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