PHARMACIST ASSESSMENT - GERD Patient Name ... - medSask - medsask usask 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name, address, and telephone number in the designated fields. Ensure accuracy for effective communication.
3. Fill out the medical history section, checking relevant boxes for renal dysfunction, gender, date of birth (DOB), health service number (HSN), and any other pertinent conditions.
4. In the drug history section, document recent and current medications along with any known drug allergies to provide a comprehensive overview.
5. Proceed to patient history questions. Select 'Yes' or 'No' as applicable for each question regarding age, pregnancy status, medication effects, and previous GERD diagnosis.
6. Complete the review of symptoms section by indicating whether alarm symptoms are present and if symptoms align with GERD diagnosis.
7. Based on symptom severity, recommend appropriate treatments from the options provided. Document rationale for prescribing if necessary.
8. Finally, fill in your details as the prescribing pharmacist including name, pharmacy information, contact details, and signature before saving or sharing the completed form.

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