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 Form Fda 3664 2011-2023

Form Fda 3664 2011-2023

Use the medicine record 2011 template to simplify high-volume document management.

Last First Middle Initial Birth Date mm/dd/yyyy What I m Using Rx Brand generic name OTC Name active ingredients What It Looks Like How Much Color shape size markings etc* How to Use / When to Use Start / Stop Dates Notes Who Told Me to Use / How to Contact Enter ALL prescription Rx medicine include samples over-the-counter OTC medicine and dietary supplements Ex XXXX/xxxxxxxxxx 20 mg pill small white round 40 mg use two 20 mg pills Take orally 2 times a day at 8 00 am 8 00 pm 1-15-11...
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