Current Medications

Name
First Last
Date
MM slash DD slash YYYY
Current Medications:
Name of Medication and Dosage Daily Amount Taken For Which Condition Name of Prescribing Doctor Side Effects
Current Medications:
Name of Medication and Dosage Daily Amount Taken For Which Condition Name of Prescribing Doctor Side Effects
Current Medications:
Name of Medication and Dosage Daily Amount Taken For Which Condition Name of Prescribing Doctor Side Effects
Current Medications:
Name of Medication and Dosage Daily Amount Taken For Which Condition Name of Prescribing Doctor Side Effects
Current Medications:
Name of Medication and Dosage Daily Amount Taken For Which Condition Name of Prescribing Doctor Side Effects
Current Medications:
Name of Medication and Dosage Daily Amount Taken For Which Condition Name of Prescribing Doctor Side Effects
Current Medications:
Name of Medication and Dosage Daily Amount Taken For Which Condition Name of Prescribing Doctor Side Effects
Current Medications:
Name of Medication and Dosage Daily Amount Taken For Which Condition Name of Prescribing Doctor Side Effects
Current Medications:
Name of Medication and Dosage Daily Amount Taken For Which Condition Name of Prescribing Doctor Side Effects
Comments
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Name of Medication and Dosage	Daily Amount Taken	For Which Condition	Name of Prescribing Doctor	Side Effects