My Medication List

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My Medication List
My Doctor’s Name:
My Name:
/
/
My Doctor’s Phone Number:
Today’s Date:
When do I take
Drug
Why do I take
How much
How to take
this drug?
Name
this drug?
should I take?
this drug
/
/
My Next Doctor’s Visit:
Do you have questions for your doctor?
Yes
No
If yes, what are your questions? (Please list)
For more information, please visit: and or call: 888-522-1298

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