Medications Girl’s Name: ________________________________________________ Date: __________________________ Please list the name(s) of any medications that should be taken on an as needed basis: Name of Medication Dose Take with Food Other Instructions Example: Advil 400 mg No Not more than 4 times a day
Medications Girl’s Name: ________________________________________________ Date: __________________________ Please list the name(s) of any medications that should be taken on an as needed basis: Name of Medication Dose Take with Food Other Instructions Example: Advil 400 mg No Not more than 4 times a day
her_power_authorization_and_health_form_2018.docx