EFTA00314173.pdf

III PRIORITY PRIVATE CARE MEDICATIONS Please list prescriptions and non-prescription medicines, vitamins, herbs, etc. that you take, as well as the dose taken and how many times taken per day. Identify all Prescription Medications you take, dosage and how often (frequency) Identify all Over-the-Counter Medications you take, dosage and how often (frequency). Be sure to include all vitamins 170 East 77th Street, New York, NY 10075 646.535.8939 priorityprivatecare.com EFTA00314173