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Get Universal Medication Form For Florida

Mergency Contact/Phone numbers: Universal Medication List Date form started: uml UML UML Address: IMMUNIZATION RECORD (Record the date/year of last dose taken, if known) TETANUS FLU VACCINE(S) PNEUMONIA VACCINE HEPATITIS VACCINE Allergic To / Describe Reaction: OTHER Allergic To / Describe Reaction: LIST ALL MEDICINES YOU ARE CURRENTLY TAKING: Prescription and over-the-counter medications (examples: aspirin, antacids) and herbals (examples: ginseng, gingko). Include medications taken a.

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