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Medical Information Patient Name: DOB: Date: Height: Weight: Shoe Size: Width: What is the Foot or Ankle Problem that brings you to our office? (Please be specific): Pharmacy Name: City: pH# Family
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Medication allergies occur when the body has a harmful immune response to a medication.
Individuals who have medication allergies are required to report them to their healthcare providers.
Medication allergies can be filled out by providing a detailed list of medications that a person is allergic to.
The purpose of reporting medication allergies is to prevent potentially harmful reactions to medications.
Information such as the name of the medication, the type of reaction experienced, and any other relevant details must be reported on medication allergies.
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