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PASCO COUNTY, FLORIDA INTEROFFICE MEMORANDUM TO: Development Review Committee DATE: 4/17/08 FILE: DR081119 SUBJECT: Walgreens at U.S. 19 and Darlington Road Variance Requests (VAC08395) DRC: 4/24/08,

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How to fill out Walgreens 19 and Darlington:

1. Obtain the form: The Walgreens 19 and Darlington form can be obtained from the Walgreens website or by visiting a Walgreens store in person.
2. Read the instructions: Before filling out the form, carefully read the instructions provided. This will ensure that you understand the purpose of the form and the information required.
3. Provide personal details: Start by filling out your personal details, including your full name, address, contact information, and any other requested identification information.
4. Fill in the purpose section: State the reason for filling out the form in the purpose section. This could include medication refills, prescription transfers, health screenings, or any other specific request.
5. Enter prescription details (if applicable): If you are filling out the form for prescription-related purposes, provide the necessary details such as the prescription number, medication name, dosage, and any specific instructions.
6. Include any additional information: If there are any additional details or requests you need to mention, ensure to include them in the designated section of the form.
7. Sign and date: Once you have filled out all the required information accurately, sign and date the form indicating your agreement with the provided information.

Who needs Walgreens 19 and Darlington:

1. Patients/Customers: Individuals who are seeking to refill their prescriptions, transfer their prescriptions from another pharmacy to Walgreens, or avail themselves of other healthcare services provided by Walgreens may need to fill out the Walgreens 19 and Darlington form.
2. Healthcare Providers: Doctors, nurse practitioners, or other healthcare providers may need to fill out the form when prescribing medication or referring patients to Walgreens for specific medical services.
3. Caregivers or Family Members: If you are filling out the form on behalf of someone else, such as a family member or friend, who is unable to do so themselves, you may need to complete the Walgreens 19 and Darlington form. This allows you to act as the authorized representative for the individual in managing their healthcare needs.

Note: The specific requirements for filling out the Walgreens 19 and Darlington form may vary, so it is always recommended to carefully review the instructions provided with the form or seek guidance from a Walgreens pharmacist if needed.

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Information about the financial transactions, including amounts, dates, and parties involved, must be reported on Walgreens 19 and Darlington.

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