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Get PA Universal Medication Form

Rmacy. List the pharmacy name, phone number, and location in case there are questions about your medicines. ƒƒ List of medicines. Write the brand and generic name of each medicine, your dose, how often and how (by mouth, under your tongue, injection, etc.) you take it. List the reason you take the medicine. Note the date you started taking it. If you stop taking a medicine, draw a line through it and list the date you stopped taking it. List all tablets, patches, drops, ointments, injections, .

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