Patient Name____________________________________________________________________ Date ____________
Pharmacist Referral and Visit Summary ___ Today you were prescribed the following hormonal contraception: ____________________________ (Notes: ________________________________________________________________________________) If you have a question, my name is __________________________________________________________ Please review this information with your primary care or women’s health provider. - or – ___ I am not able to prescribe hormonal contraception to you today, because:
□ Pregnancy cannot be ruled out. (Notes: _______________________________________________________) □ You have a health condition than requires further evaluation. (Notes: __________________________) □ You take medication(s) or supplements that may interfere with patches or pills. (Notes: _______________) □ Your blood pressure reading is higher than 140/90 units. ( _____/_____ ) Each requires additional evaluation by another healthcare provider. Please share this information with your provider. Pharmacist Name_________________________________________________________________ Pharmacy Name__________________________________________________________________ Address_________________________________________________________________________ Phone__________________________________________________________________________
Attention Pharmacy: This is a template document. Please feel free to customize it to your particular company, however you must retain all elements set forth by this template.
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3. IN view of the earlier order, we direct the first. Respondent to take necessary steps for recovery of the amount as. per the letter submitted by Respondent No.
Page 2 of 3. 2. Sequence One : LISTEN AND CONSIDER (pp.46-52). A- Getting started ( p.46). The picture shows two men sitting round a table. One of them, seemingly a businessman on the. left, is giving some under-table money to the other one as a brib
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3. IN view of the earlier order, we direct the first. Respondent to take necessary steps for recovery of the amount as. per the letter submitted by Respondent No.
Nov 21, 2017 - This guidance document addresses a number of questions which stakeholders, in particular the marketing authorisation holders (MAHs), may have on Article 34 referral procedures to the Committee for Medicinal Products for Veterinary Use
Nov 21, 2017 - This guidance document addresses a number of questions which stakeholders, in particular the applicants or marketing authorisation holders (MAHs), may have on Article 35 referral procedures to the Committee for Medicinal Products for V
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