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Get DA 7625-1 2009-2024

Tions Part C - Medications Child is on medications on a regular basis Yes (If yes, please list medications and indicate which require administration during child care hours.) No Part D - Early Intervention and Special Education Child has an Individualized Family Service Plan (IFSP), Individualized Education Plan (IEP) or 504 plan No Yes Part E - Exceptional Family Member Program (EFMP) Enrollment Child is enrolled in the EFMP No I authorize Yes (specify for what condition) (name of Medic.

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