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1081 Bernard Street Vancouver, BC Canada V6Z 1Y6Tel 18554068539 (toll-free) or 6048068539 Fax 6048068255Antiretroviral Medication Return Premedications being returned from: ___ Contact Phone# ___Medications
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How to fill out antiretroviral medication return form

01
Obtain the antiretroviral medication return form from the healthcare provider or pharmacy where the medication was obtained.
02
Fill in your personal information, including name, date of birth, contact information, and any patient identification numbers provided by the healthcare provider.
03
Provide details about the antiretroviral medication being returned, such as the name of the medication, dosage strength, quantity, and the reason for returning the medication.
04
Sign and date the form to confirm that the information provided is accurate.
05
Return the completed form to the healthcare provider or pharmacy where the medication was obtained.

Who needs antiretroviral medication return form?

01
Individuals who have been prescribed antiretroviral medication but no longer require it.
02
Patients who have changed their antiretroviral medication regimen and need to return unused medication.
03
Caregivers or family members who are returning unused antiretroviral medication on behalf of a patient.
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The antiretroviral medication return form is a document used to report the return of unused or expired antiretroviral medications.
Healthcare facilities and organizations that dispense antiretroviral medications are required to file the return form.
The form must be completed with details of the unused or expired medications being returned, including the quantity, lot number, and expiration date.
The purpose of the form is to track and monitor the return of unused or expired antiretroviral medications to ensure proper disposal and prevent misuse.
The form must include details such as the name of the medication, quantity returned, lot number, expiration date, and reason for return.
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