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Get Canada CHU Sainte-Justine Medication Reconciliation Medication History

History sources (check all sources used)      Community pharmacy contact INFO  Parents/tutors  Hospital list  Community pharmacy list Patient Medications (labels, bottles) Personal list Medical record Other(specify) : Name  contacted Phone number Medications and others treatments taken in the past 2 weeks (including inhalers, ear/eye drops, creams, gels, suppositories and any other “over-the-counter” (OTC) medications etc.) Name Dose Route Frequency Dat.

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