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Name of child__________________________________________ Grade__________ Date of Birth___________________
Condition for which drug(s) are being administered during school hours: _________________________________________
PRESCRIBER’S ORDER: If child is exposed to, ingests, or is stung, follow the selected treatment plan (A or B) C<;B&;E& &FFFFFF& Immediately administer epinephrine (adrenaline) by intramuscular injection, G#%,(H%&G"#%#$I&to see&
whether or not signs or symptoms of an allergic reaction occur. Call 911 for transport to the emergency room. Administer an antihistamine by mouth.
�!=+#+*$&'1J&7JKLMI&#$%1"MH)-H."1.N& &�!=+#+*$&7JOMI&#$%1"MH)-H."1.N "$4&"4M#$#)%*1&"$%#,#)%"M#$*E& P#+,*$,N41"M#$*&*.#Q#1&R0*$"41N.S&KTJLMIULM.&E&;4M#$#)%*1&VN&M(H%,& A"12&4()"I*E& �!KTJLMI&&&&�!TLMI&&&&�!L7MI&&&&�!B(&"$%#,#)%"M#$*& D%,*1FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF& & & C<;B&0E& Administer an antihistamine by mouth, observe the patient for signs or symptoms of allergy* for one hour. W3&)#I$)&(1&)NM+%(M)&(3&".*1INX&(--H1&"4M#$#)%*1&*+#$*+,1#$*&VN&#$Y*-%#($&"$4&-".&ZKK&for transport to P#+,*$,N41"M#$*&*.#Q#1&R0*$"41N.SE&KTJLMIULM.&E&;4M#$#)%*1&VN&M(H%,& A"12&4()"I*E& �!KTJLMI&&&&�!TLMI&&&&�!L7MI& D%,*1FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF&
"!W3&)#I$)&(1&)NM+%(M)&(3&".*1IN&(--H1&"4M#$#)%*1&*+#$*+,1#$*&
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�!=+#+*$&7JOMI&#$%1"MH)-H."1.N& *** SIGNS AND SYMPTOMS OF AN ALLERGIC REACTION INCLUDE:
itching of throat, sense of tightness in the throat, hoarseness, difficulty swallowing
hives, itchy rash, swelling of face or extremities
nausea, abdominal cramps, vomiting, diarrhea
shortness of breath, repetitive coughing, wheezing, chest tightness
dizziness, faintness, loss of consciousness
Medication to be administered from _________________ to _________________.& & Relevant side effects to be observed, if any: Epipen = jitters & tachycardia, Benadryl = sedation.
If there are side effects, plan for management: Call physician if symptoms do not resolve spontaneously.
Authorized Prescriber’s Signature: _______________________________________ Date _______________________
Authorized Prescriber’s Name (printed): _______________________________________ Telephone: __________________
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AUTHORIZATION BY PARENT/GUARDIAN FOR THE ADMINISTRATION OF THE ABOVE MEDICATION BY SCHOOL PERSONNEL 6(E&!-,((.&C*1)($$*.& & I hereby request that the above medication, ordered by the MD, DDS, OD, APRN or PAC for my child be administered by
school personnel. I understand that I must supply the school with the prescribed medication in the original container
dispensed and properly labeled by a physician or pharmacist and will provide no more than a 45 school day supply of said
medication. I understand that this medication wil be destroyed if it is not picked up by the last day of the school.
Signature: _____________________________________ Relationship to child: _____________ Date: _________________
Name: (print) ___________________________________Telephone: (H) __________________ (W) __________________
1. Subject Area: Community Reinforcement Approaches Manual Two of Therapy Manuals for Drug Addiction. A Community Reinforcement Plus Vouchers Approach: Treating Cocaine Addiction Author/s Individualized or Group Outcome/s Subjects Info Randomized Controlled Generalizable to Iowa? Intervention? Measures interventions are involved is a treatment Citation Budney,
PROGESTERONE GENERAL DESCRIPTION Progesterone is a steroid hormone produced in the ovaries (corpus luteum) and adrenal glands. One of its Progesterone is also produced by the brain and peripheral nerves, and possibly other locations. Normally, women have much more progesterone at any given time, than estrogen. KNOWN FUNCTIONS OF PROGESTERONE 1. Balances the effects of estrogen