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Get MN Medication Tracking Form 2007-2024

R(s): Pharmacies, other sources: Immunization Record (Record the date/year of last dose taken) Pneumonia vaccine: Tetanus: Flu vaccine(s): Hepatitis vaccine: Other: (type) date: List all medicines you are currently taking. Include prescriptions (examples: pills, inhalers, creams, shots), over-the-counter medications (examples: aspirin, antacids, vitamins) and herbals (examples: ginseng, gingko). Include medications taken as needed (example: , inhalers). START DATE NAME OF MEDIC.

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  • antacids
  • Immunization
  • gingko
  • Providers
  • inhalers
  • ginseng
  • creams
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  • org
  • clinics
  • Medicines
  • Tetanus
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  • prescriptions
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