Community Recreation Services A Medication Administration and Health Care Provision Form Section 1 TO BE COMPLETED BY PARENT GUARDIAN Name of Participant: _____________________________________________________________ Par - Hypersensitivity - Document - PDFSEARCH.IO

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	Community Recreation Services A Medication Administration and Health Care Provision Form Section 1 TO BE COMPLETED BY PARENT/GUARDIAN Name of Participant: _____________________________________________________________ Par Add to Reading List Document Date: 2014-05-01 13:11:09 Open Document File Size: 14,32 KB Share Result on Facebook MedicalCondition diarrhea / loss of consciousness / __vomiting / LIFETHREATENING ANAPHYLACTIC REACTION / choking __difficulty breathing / anaphylaxis / __stomach cramps / __coughing / voice __fainting / skin __dizziness / personal injury / / Organization Recreation Office / Medication Administration / Saanich Recreation Services Department / / / Position PHYSICIAN / / Product Participant’s Full Name Date Medication / / SocialTag Anaphylaxis Type 1 hypersensitivity Epinephrine autoinjector Medicine Health Allergology

Community Recreation Services A Medication Administration and Health Care Provision Form Section 1 TO BE COMPLETED BY PARENT/GUARDIAN Name of Participant: _____________________________________________________________ ParAdd to Reading List