Page 292 - tmp
P. 292

DRUGS TO TAKE HOME (including weekend leave)
                                    Maximum supply - 28 days unless specially requested



                                                                  QUANTITY
                                                                     OR
             DATE DRUGS (Approved name) and FORM  DOSE  FREQUENCY  DURATION      SIGNATURE         PHARMACY




















































                                                                  87
   287   288   289   290   291   292   293   294   295   296   297