English - 4968-47e - Personal Medication Record
Using the standardized fax template, pharmacists must share the completed MedsCheck Personal Medication Record with the patient's primary prescriber. A record of the successfully transmitted fax must be kept on file at the pharmacy.
Additional Information
| Last updated | November 8, 2022 |
|---|---|
| Created | December 11, 2021 |
| Format | application/pdf |
| Form Number | https://forms.mgcs.gov.on.ca/dataset/54de3de1-3bcd-4db5-9432-c63f7dc025d7/resource/f0a01193-f11c-47cb-83cd-a0aa4ba7a486/download/4968-47e.pdf |
| Form File Identifier | |
| Name | English - 4968-47e - Personal Medication Record |
| Form File Status | Available |
| Description | Using the standardized fax template, pharmacists must share the completed MedsCheck Personal Medication Record with the patient's primary prescriber. A record of the successfully transmitted fax must be kept on file at the pharmacy. |
| Language | English |
| Functionality | Fill, Print, and Save |
| Form File Content Type | Form |
| Remark | Form update with references to Queen’s Printer to reflect the change in sovereign to King’s Printer |
| Edition Date | 2022-11 |