CHECKLIST - Medipac
The term “medication” includes nitroglycerin in any form. 9f YES NO YES NO IF YOU ANSWERED ... “medication” excludes tamoxifen and ANY other hormone treatment. 5 YES NO 6 During the 3 MONTHS prior to ... muscular dystrophy, myasthenia gravis, cerebral palsy, multiple sclerosis or dementia (including Alzheimer’s disease)? 7 YES NO 8 Do ...
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