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Get and Sign DIRECTLY OBSERVED THERAPY DOT LOG Case TBI Form
Color Loss of Appetite Headache/Dizziness Abdominal Pain Nausea/Vomiting/ Diarrhea Patient weeks taken Yes Comments Number of doses VET Self or Clinician Notified of Adverse Reaction Frequency of administration VDH TB 03/2019 None Initials of Person Observing or Giving Medication Time When Day of Dose If Self-Administered Check the Meds. Month Self Box and Note the Reason Observed in the Comment Column Calculate weeks of treatment this month Side Effects If present check and write progress...
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