ࡱ> SURk bjbj 1.}}!lB B B 8z  |6     U U U $ !tU Q U U U    ; U    U   1:), лOZB k "U 06_R! !  Personal Medication Log This Personal Medication Log is a tool to help you track all medications you are taking, who prescribed them and record effects and side effects. Take a copy of this log with you every time you see a doctor, so he/she is aware of all the medications that you use and their effects. Patient Name: Allergies/ Drug Reactions: Name of MedicationDate began taking/Date doctor stopped medicationDosage (Example: 10 mg)How much to take and when (Example: 1 tablet daily)Effect(s) experienced (Example: improved sleep)Side effect(s) experienced (Example headache)Prescribing Doctor Name/ phone number       Important Phone Numbers: Primary Care Physician: ______________________________ Pharmacy: ________________________________ Psychiatrist: _________________________________________ Therapist: ________________________________ Hospital: ___________________________________________ CIGNA Behavioral Health, (2004 578EFeg(CXl~>MԾǯymdd] CJOJQJCJOJQJ^J5CJOJQJ\^J5>*CJOJQJ\^J5B*CJOJQJ^JphB*CJOJQJ^JphB*CJOJQJ^Jph5B*CJOJQJ^JphCJOJQJ^JB*CJOJQJ^JphB*CJOJQJ^Jph5B*CJOJQJ^JphjCJOJQJU^JaJ"789GHIde $$Ifa$ <<$If $If$a$$a$ efgzni\\\\\\\\ $$Ifa$d$$Ifl4\~t"4N 0t44 la (CXl( $IfFf!. $$Ifa$5(+++ $If$$Ifl4֞$ &-4 p$ T0t44 la $If5(+++ $If$$Ifl4֞$ &-4 p$ T0t44 la $If5(+++ $If$$Ifl4֞$ &-4 p$ T0t44 la $If5(+++ $If$$Ifl4֞$ &-4 p$ T0t44 la $If5(+++ $If$$Ifl4֞$ &-4 p$ T0t44 la $If=53333$$Ifl4֞$ &-4 p$ T0t44 la=>$a$ CJOJQJ jB*CJph B*CJph/&P1h0= p5!"#$% !.Dd 0  # Ab-d.ԙj{ܣ3_ Sy-Dnq-d.ԙj{ܣ3_ SPNG  IHDR@&[gAMA|Q pHYs./.V]/r-IDATx^} xŕ憄CF~$GQ+4V\mt]cY-v?g.b+iV?>k6m6ԟ$ZIPW0y}o{dy}̙3g{̙33io||=3H0|D`"0\:>>>:y[B`@2៬aOz><~hD|F[Ug |\=EtY.*6)&[[R8(IJ=F{\V5P{˧V*Հ}WWSP~+^ʦI|f[ҫ$4#A$I+yPkpj)B{J%i䵤aOq' c-ImF0 P8Dq'_dX(q,0֘=d&C jsn10;X4v] ĐpJ)߇}JC<; rL/f`C3|zw7mR϶g7LK9GKMp ⇶{)Ei}?k4An8`vE^[߾ N6ܮ1NcYVNr$ ӛ0c׶~/4^w*r \Xվ MC q7Ar誙}NM6Fz8/Fm $T1Epo"sJ1gsk$Ja(iEy:#r@u8p0V%j\6.>&e}*^lj S;@;l=OikvB aYCd;6sU}(^EvAlJ"- 2, }ܖ)!MC6lFBّ-h焤0r"HFjű+af\j GNDNKBoeEP% Z4"aP't 'B6CLZ٤|]ҿZl&HF`<Euk-,0_Ղ6r=MxuGyը[?5eEI)ȫ 0%6Q ORA`CFMd)ZUX OZLCe:9suȫǼ`Bˉwqk[X2gƥT2:?DنJ`WO' DV{ڏd.N `jz }J sGL?3 @$^˵PG@s$aЩT(tS'LիFoϒe%V"Kil|㦏 9i7tS{uJW`9(H*9*eF|:q``zm?r 7 Boβt4o1H(t)Wnx^KMq *ӱ`J;M cE B)1\>\3ơ`87>ai%[Z=ЍN&G| XĮ_l,?)v٥t. 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