English - 4976-47e - Healthcare Provider...
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 22, 2022 |
|---|---|
| Created | December 11, 2021 |
| Format | application/pdf |
| Form Number | https://forms.mgcs.gov.on.ca/dataset/d9e64054-765f-411e-b653-0d2354351368/resource/e3868eac-91d3-40ce-b8c6-04fe11f755e3/download/4976-47e.pdf |
| Form File Identifier | 014-4976-47e |
| Name | English - 4976-47e - Healthcare Provider Notification of MedsCheck Services |
| 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 | |
| Edition Date | 2022-11 |