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Free Printable Medical Forms MEDICATION

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									                                                                                                                      MEDICATION CHECKLIST
                                                                                                                      Unsure how to communicate with your doctor?
                                                                                                                      Fill out this form to take with you to your next
                                                                                                                      medical appointment. Compliments of eHealth
                                                                                                                      Forum, an online health service available 24/7.
Find answers to your medical questions
Visit http://ehealthforum.com today
You may be taking many different medicines, numerous vitamins and over-the counter drugs. It can be confusing to keep track of everything! This form can help. Because your
medication regimen may change over time, make a copy of the blank form so you will always have a clean copy to use. Bring a completed and updated copy of this form to every
doctor appointment.

                                       PRESCRIBING                               START      COLOR       DOSE           DOSE
NAME OF DRUG                                            WHAT IS IT FOR?                                                                  INSTRUCTIONS FOR USE
                                       DOCTOR                                    DATE       SHAPE       (mg)        (frequency)

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