Medication Review Form Brown Bag Program Name Physician - pskills pharm ku 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Demographic Information section. Enter your name, age, physician's name, height, occupation, insurance details, weight, gender, and annual income by circling the appropriate range.
3. Proceed to Health History. Describe any allergies and adverse drug reactions. Note current medical concerns and past medical history or surgeries.
4. In the Social History and Lifestyle section, indicate tobacco and alcohol use. List any nonprescription medications along with their details such as drug name, strength, schedule of therapy, and reason for use.
5. Complete the Patient Medication Profile by documenting each medication bottle's information including drug name, strength, dosage form, MD name, quantity & days supply.
6. Review the Drug Utilization Review section for potential issues like overutilization or underutilization of medications. Answer all questions regarding compliance and appropriateness of therapy.

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