Bellingham Arthritis & Rheumatology Center

Name: Date: 1) Medication name, strength and frequency 2) Medication name, strength and frequency 3) Medication name, strength and frequency 4) Medication name strength and frequency 5) Medication name strength and frequency 6) Medication name, strength and frequency 7) Medication name, strength and frequency 8) Medication name, strength and frequency 9) Medication name, strength and frequency 10) Medication name, strength and frequency

Allergies

1) Allergy/Type of reaction 2) Allergy/Type of reaction 3) Allergy/Type of reaction 4) Allergy/Type of reaction 5) Allergy/Type of reaction