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Medication Tracker Name of Pharmacy: Address

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Medication Tracker Name of Pharmacy: Address
Medication Tracker
In case of emergency, contact:
Pharmacy Information
Name of Pharmacy:
Address
CityStateZip Code
Phone Number: (
)
Fax Number: (
)
Remember to cross out any medications you are no longer taking!
Name of
What is
Date
medication: medication prescribed:
for?
Example:
Tylenol
Pain Relief
10/8/2012
Doctor that
prescribed
medication:
Dr. Smith
How
much?
(dose)
400 mg
How
often?
Every 4
Hours
Directions for
taking
medication:
Take with
Food
Side
effects:
Nausea
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