Medicine_List

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					Name: ___________________________                     Date: __________________

                           ILLINOIS BARIATRIC CENTER
                                MEDICATION LIST
What medications do you take on regular basis? Include over-the-counter and any herbal
medications.


         NAME                 DOSAGE      FREQUENCY        WHAT IS THIS DRUG BEING
                               (Mg)         (TIMES               TAKEN FOR?
                                           PER DAY)

				
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