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Get Request For Section 504 Accommodations 2017-2018 - New York City...

Sult with and obtain any further information they may deem appropriate relating to your child s medical condition, medication and/or treatment, from any health care provider and/or pharmacist that has provided medical or health services to your child. Completed HIPAA form attached (REQUIRED FOR REVIEW; PARENTS MUST COMPLETE THE BACK OF THIS FORM). Name of Parent/Guardian Daytime Phone Number Signature of Parent/Guardian.

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