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Premier # REQUIRED AT THE TIME OF YOUR APPOINTMENT Today's Date: Date of Birth Name: Your Pharmacy Name CURRENT MEDICATION LIST all prescription and over the counter medications you are currently
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Required forms must be filled out and submitted.
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What is the purpose of required at form time?
The purpose is to gather and report necessary information.
What information must be reported on required at form time?
Information such as financial data, personal details, and other relevant information.
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