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Academy of the Holy Family 54 W Main Street * P O Box 691 * Baltic CT * 063300691 (School) (860) 8229272 * Fax (860) 8221318 Email: schoolnurse@ahfbaltic.orgOVERTHECOUNTER MEDICATION AND/OR NON ASPIRIN
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01
Read the instructions on the medication label carefully.
02
Fill out your personal information, including name, date of birth, and address.
03
Provide information about your medical history, including any allergies or current medications you are taking.
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Specify the medication you are requesting and the reason for needing it.
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Sign and date the form before submitting it to the pharmacist.

Who needs over form counter medication?

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Anyone who needs over the counter medication for minor ailments such as headaches, colds, or allergies.
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Individuals who are looking for a convenient way to purchase medications without a prescription.
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Over-the-counter (OTC) medication refers to medicines that can be purchased without a prescription, used to treat various ailments like pain, cold, allergies, and more.
Pharmacies, healthcare providers, or manufacturers who deal with OTC medications may be required to file reports depending on local regulations.
To fill out the form, individuals must provide specific information about the medication, including the name, dosage, quantity, and any relevant patient information if applicable.
The purpose is to document and regulate the sale and distribution of OTC medications to ensure safety and compliance with health regulations.
Information typically required includes the medication name, manufacturer, active ingredients, dosage form, and distribution quantities.
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