La tétracycline, connue sous le nom commercial Sumycin, agit en bloquant la fixation de l’ARNt sur la sous-unité 30S ribosomale, interrompant l’élongation de la chaîne protéique bactérienne. Ce mécanisme confère une activité sur un spectre large, incluant bactéries Gram positives, Gram négatives, rickettsies et spirochètes. Sa biodisponibilité digestive varie selon la prise alimentaire et les interactions avec les ions divalents comme calcium et magnésium. Sa diffusion tissulaire est importante, notamment dans les voies respiratoires et génito-urinaires. L’élimination se fait par voie rénale et biliaire. Les effets indésirables incluent photosensibilisation, troubles digestifs et coloration dentaire en cas d’administration précoce. Les guides thérapeutiques mentionnent sumycin prix, en soulignant la nécessité de restreindre son utilisation afin de limiter les résistances acquises.

Medical_form 2010-11[1]

PARENTAL STUDENT RELEASE FORM
Regarding: The Bolton High School Band Events for the 2010-2011 school year

Name (one form per student)____________________________________________________
Address______________________________________________________________________
City_________________________ State ________________ Zip Code __________________
Telephone___________________ DOB________________ Grade_______ Sex __________
Email Address ________________________________________________________________
Student’s Social Security #______________________________________________________
Medical History (mark if a problem):
____ Diabetes ____ Epilepsy _____ Asthma
____ Allergies (i.e., food, medicine, etc.) ___________________________________________
Other Medical Conditions ______________________________________________________
Prescription Medications _______________________________________________________
If needed, mark any of the over-the-counter medications the student may take:
____ Tylenol

____ Cortaid Cream
____ Cough Syrup/Drops
____ Ibuprofen
____ Pepto Bismol
____ Throat Lozenges
____ Sudafed
____ Benadryl
____ Neosporin Ointment
____ Imodium
____ Eye Drops
____ Betadine (to clean cuts)
____ Dramamine (for motion sickness)
I, _________________________________ (name of parent/guardian) give permission for
Mr. David E. Chipman, Director of Bands, or any adult named by Mr. Chipman to act in
my behalf to approve appropriate medical treatment for my son/daughter
_____________________________________ should an emergency medical treatment be
necessary and will make any necessary financial reimbursements. I further state that I am
of lawful age and legally competent to sign this Medical Release; that I understand that the
terms herein are contractual and are not a mere recital; and that I have signed this
document as my own free act. I agree to release and hold harmless Mr. Chipman or his
nominee from any liability for decisions made pursuant to their authorization.
I have fully informed myself of the contents of the Medical Release by reading it and that
the medical and insurance information I give below is accurate.
Name of Insurance Company____________________________________________________
Account Number______________________________________________________________
Doctor’s Name & Phone________________________________________________________
Signature of Parent/Guardian___________________________________________________
Emergency Phone Numbers ____________________________________________________


Sworn to and subscribed before me this _______ day of _______________, 200____
Notary’s signature_________________________ Commission expires____________

Source: http://boltonband.org/Medical_Form%202010-11%5B1%5D.pdf

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