Current Medications: List or attach all medications taken routinely or on an as needed basis.
Add Additional Medication
Past Medications used for Allergy and Asthma (include oral and topical corticosteroids, antihistamines, inhalers and nose sprays)
Allergies: include drug allergies, insects, environmental
Add Additional Allergies
Hospitalizations or ER visits in the past 5 years?
Add Additional Hospitalization
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