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Get UNR Medication Therapy Management (MTM) Program - Information Form 2015

Ill complete the attached MTM Information Form listing all my medications and supplements and agree that this information may be shared with the clinical certified geriatric pharmacist (PharmD, CGP) at IntegriCare Clinical Associates who will review my application and look for any problems I might be experiencing. Based on the evaluation of all my prescription drugs, over-the-counter medications, and dietary supplements, the pharmacist will provide me with recommendations for changes in my medic.

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