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Get HEA 7758 2011-2024

N Record (MAR) General Medication Form (Including Asthma Inhaler and Epinephrine Autoinjector Use) Student Information Student name Date of birth Student address School Grade/Class Teacher School year List any known drug allergies/reactions Height Weight Prescriber Authorization Name of medication Circumstance for use Dosage Route Date to begin medication Date to end medication Time/Interval Circumstances for use Special instructions Treatment in the event of an adverse reaction .

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