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Appendix exp. 7192 2.12a A113 MEDICATION SURVEY FORM BER: II CONTACT YEAR: he: I I I I I I I I I I I I I I FOREBODE: INITIALS: MSR CII VERSION: B Of I public reporting burden for this collection of

How to fill out medication a-113 survey form

How to fill out medication a-113 survey form:

1. Ensure you have all the necessary information and documents ready before starting the form.
2. Begin by entering your personal details accurately, such as your full name, date of birth, and contact information.
3. Provide the required medical information, including any pre-existing conditions, ongoing medications, and allergies.
4. Answer the survey questions truthfully and to the best of your knowledge, as this information will be used for medical purposes.
5. If there are any additional sections or questions on the form, make sure to fill those out as well.
6. Double-check all the entered information for accuracy and completeness before submitting the form.

Who needs medication a-113 survey form:

1. Individuals who have been prescribed or are currently taking medication a-113 may need to fill out this survey form.
2. Healthcare professionals or researchers collecting data on the effectiveness and side effects of medication a-113 may require individuals to complete the survey form.
3. It can be beneficial for patients to fill out the form as it helps in tracking their progress and monitoring the medication's impact.

Note: The specific reasons for needing the medication a-113 survey form may vary depending on the context and purpose of the form.

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