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Drug Regimen Review Request

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Brand Sage
MPN 3541
Packaging 100 pad
Size 8 1/2 X 11
This form is used to notify the pharmacist of the need for a Drug Regimen Review (DRR) for specific reasons other than the monthly DRR.  It is designed for FAX/electronic transmission between the long-term care facility and the pharmacy.

Download a sample today!

  • 8 1/2 X 11
  • 100 pad
  • Punched side and top
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