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OTC medication (non-work related) self-selected by the employee.
Allergies: NKDA****
Current Medications: Denied ****
Medical condition (Reason for request):*****
Selected OTC Medication information:
NDC: 0000-0000-00 Lot: Exp:0/202 Dose: Manufacturer OTC Recommendation/OTC
Medication directions, warnings, and directions were available to the employee at the time of the request.
Female: Denies chance of pregnancy *****
If there is a change in the acute discomfort, the recommendation is to immediately contact your PCP or seek emergency medical services.
OTC medication (non-work related) self-selected by the employee.
Allergies: NKDA****
Current Medications: Denied ****
Medical condition (Reason for request):*****
Selected OTC Medication information:
NDC: 0000-0000-00 Lot: Exp:0/202 Dose: Manufacturer OTC Recommendation/OTC
Medication directions, warnings, and directions were available to the employee at the time of the request.
Female: Denies chance of pregnancy *****
If there is a change in the acute discomfort, the recommendation is to immediately contact your PCP or seek emergency medical services.

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