AF 312 Prescribed Medication

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Form – Parent Request for Prescribed Medication
PHYSICIAN’S STATEMENT
I, Dr. ______________________ am the physician for ___________________________.
I have read the parent Request Form for Prescribed Medication.
I hereby confirm:
That the administration of the medication referred to therein does not require the
training and/or experience of a physician, nurse or other medical personnel.
Dated this _______day of ______________20___ at _______________, Saskatchewan.
_________________________________
Physician
____________________________
Date
_________________________________
____________________________
Date
Superintendent of Learning (Student Services)
Superintendent of Learning (Safe and Caring Schools)
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