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S:\LINCOLN FORMS\Lincoln Front Office\New Patient Cataract Information\MEDICATION
SHEET.doc
Patient Name_______________________________ Date____________________
MEDICATION SHEET
PLEASE LIST ALL OF YOUR CURRENT MEDICATIONS, THE DOSE, AND HOW
MANY TIMES A DAY YOU TAKE THEM
Name of Medicine
Dosage Per Day
IF YOU NEED HELP FILLING OUT THIS FORM, PLEASE
BRING ALL MEDICATIONS WITH YOU TO YOUR APPT.