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Patient Name: DOB: ALLERGIES / ADVERSE DRUG REACTIONS: Date Problems/Diagnosis Date Medications Surgeries Start Stop Date Social / Habits Tobacco: Alcohol: Date Hospitalizations: Occupation: Significant
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Combination problem amp medication is a form that combines information about both the problem and the medication being used to treat it.
Healthcare providers and medical facilities are required to file combination problem amp medication.
Combination problem amp medication can be filled out electronically or by using a paper form provided by the relevant authorities.
The purpose of combination problem amp medication is to track the use of specific medications for treating certain medical problems.
Information such as the name of the medication, dosage, frequency of use, and the associated medical problem must be reported on combination problem amp medication.
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