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Medication Authorization Form Medication Authorization Form



If your child's physician prescribes any medication for your child to take at school,
you will need to print the PDF file below, complete it and return it to St. Mary's
School Nurse.

The top part should be completed and signed by the parent, giving permission for
St. Mary's staff to administer the medication.
The bottom half should be completed and signed by your child's pediatrician.



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