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BMV OR DEPUTY USE ONLY OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLESAPPLICATION FOR DISABILITY PLACARDS Ohio Revised Code (R.C.) 4503.44SEE REVERSE SIDE FOR INSTRUCTIONS NOTE: A PRESCRIPTION
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Note a prescription form is a document used by healthcare providers to prescribe medication to patients.
Healthcare providers such as doctors, nurse practitioners, and physician assistants are required to file note a prescription form.
Note a prescription form should be filled out by providing the patient's information, the medication prescribed, dosage instructions, and the healthcare provider's signature.
The purpose of note a prescription form is to ensure that patients receive the correct medication and dosage as prescribed by their healthcare provider.
Information such as patient's name, date of birth, medication name, dosage, frequency, and healthcare provider's information must be reported on note a prescription form.
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