| Child Care Prescription and Non Prescription Medication COLOR ME HAPPY DAYCARE I _____________________________(parent), request that Michelle Gengenbacher give _________________________________________________________medication to __________________________________________(child�s name) as prescribed by Dr._________________________. This medication is to be given for ________days, beginning on_______________________and ending on__________________________. Possible side effects are:___________________________________________________ Storage and Preperation Instructions:(refrigerated, shaken, mix with water, etc.),___________________________________________________________________ Reason for needing the medication:________________________________________ Parents Signature________________________________________Date_____________ |
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