Get Da Form 5225 R
Additional CDS personnel may be designated at the discretion of the CDS Program Director. Date DATE Signature of Sponsor SIGNATURE OF PROGRAM DIRECTOR REVERSE OF DA FORM 5225-R JUL 1989. CHILD DEVELOPMENT SERVICES CDS MEDICAL DISPENSATION RECORD MONTH For use of this form see AR 608-10 the proponent agency is DCSPER. SEE REVERSE FOR PRIVACY ACT STATEMENT NAME OF CHILD MEDICATION ACTIVITY ROOM NAME OF SPONSOR HOME PHONE AUTHORIZING PHYSICIAN INCLU.
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