medical history form
Examination Confirmation Letter No. 50-182/OL-22-02, Purdue
Form 398), and Certification of Medical History by Facility Licensee (NRC Form 396), on the agencys Web site. The forms are in docHub format.
Learn more
Highlights of Prescribing Information
Risks are increased in patients with a personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g.,
Learn more
NEW PATIENT HEALTH HISTORY FORM
NEW PATIENT HEALTH HISTORY FORM. All questions contained in this questionnaire are strictly confidential and will become part of your medical record. Name
Learn more