Signature Signature Signature Inhalational CD CD CI Date Date Date Signature Signature Signature Intramuscular injection CD CD CD Date Date Date Signature Signature Signature CD CD CD Subcutaneous injection Date Date Date Signature Signature Signature Per vaginum *O/E CD CD Date Date Date Signature Signature Signature Per rectum *O/E CD CD Date Date Date IV administration of routine medicines (third year): Signature Via Cannulation CD/CS Date Signature Via direct vein access CD/CS Date
Inhalational CD Signature CD Signature CI Signature Date Date Date Intramuscular injection CD Signature CD Signature CD Signature Date Date Date Subcutaneous injection CD Signature CD Signature CD Signature Date Date Date Per vaginum *O/E Signature CD Signature CD Signature Date Date Date Per rectum *O/E Signature CD Signature CD Signature Date Date Date IV administration of routine medicines (third year): Via Cannulation CD/CS Signature Date Via direct vein access CD/CS Signature Date
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