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ASL Pharmacy ? 900 Called Plano, Suite M ? Camarillo, CA 93012 ? Tel 866-552-7579 ? Fax 866-442-7579 Patient 1. Patient Information Anti-inflammatories ? Res pules (0.5 mg) DOB: / / Age: M F Dose
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How to fill out asl rx form 8-7-07
How to fill out asl rx form 8-7-07:
01
Start by entering your personal information in the designated fields. This includes your full name, date of birth, and contact information.
02
Next, provide details about your current medical condition or ailment for which you are seeking treatment. Be as specific and concise as possible, including any relevant symptoms or concerns.
03
If you have any allergies or past medical history that is important for the healthcare professional to know, make sure to indicate it clearly on the form.
04
Indicate your preferred pharmacy where you would like your prescription to be sent. Provide the pharmacy name, address, and contact information.
05
If you are currently taking any medications, list them on the form. Include the name of the medication, dosage, frequency, and the reason for taking it.
06
Finally, sign and date the form to acknowledge that the information provided is accurate and complete.
Who needs asl rx form 8-7-07:
01
Patients who are seeking medical treatment and require a prescription from a healthcare professional.
02
Individuals who are experiencing symptoms related to a medical condition and need proper diagnosis and treatment.
03
Patients who are already on medication and need to renew their prescription or start a new one.
04
Anyone who wants to ensure that their healthcare provider has accurate information about their medical history, allergies, and current medications in order to make informed decisions regarding their treatment.
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