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UNIVERSALMEDICATIONFORM *Foldthisformandkeepitinyourwallet. Page1of2 Name: Name: Address: PhoneNumber: Birthdate: AllergicTo/DescribeReaction: AllergicTo/DescribeReaction: Listallprescriptionandoverthecounter(nonprescription)medicationssuchasvitamins,Aspirin,Tylenol,andherbals(ex:.

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