Medication Chart - PDF

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					Medication Chart
Help us care for you better by telling us what prescriptions and over-the-counter
medications you take.
Update this every time you visit.

Name of medicine          Dose (total   How many     When do take           Who prescribed it for
                          milligrams)   times per    it? (Morning and       you? (Physician’s last name)
                                        day?         night? After meals?)