Medication Log Template Page 3
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4Medication Log
PHYSICIANS
REACTIONS
Primary Care Physician
Drug Allergies and Other Significant Reactions
Prescription Name
Reaction
Phone:
Address:
Specialist
Phone:
Address:
Specialist
Phone:
Address:
Recent Medications that Caused Problems or Did Not Work
Specialist
Prescription Name
Problem
Phone:
Address:
NOTES:
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