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Er-theCounter Medications Purpose or Reason Taken Dose Time(s) of Day Form (Liquid, capsule, tablet) Special Instructions Health Problems Primary Doctor Doctor’s Phone Local Pharmacy Pharmacy Phone Drug Allergies Your Phone Your Name Date Adapted by the American Society of Consultant Pharmacists (ASCP) Foundation for the Center for Medicines & Healthy Aging Instructions for Personal Medication List • Write the name of each medication you take, the reason, the dose, etc. • I.

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Choosing a authorized expert, creating a scheduled appointment and going to the workplace for a private meeting makes completing a ASCP Personal Medication List from beginning to end tiring. US Legal Forms lets you rapidly make legally binding papers according to pre-created online samples.

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  1. Get the ASCP Personal Medication List you need.
  2. Open it up with online editor and begin altering.
  3. Fill in the blank fields; involved parties names, addresses and phone numbers etc.
  4. Change the blanks with exclusive fillable fields.
  5. Add the day/time and place your electronic signature.
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