|Classification / Identification:|
| ||Form Number:||4968-47E||Edition date: ||2016/07 |
| ||Title:||Personal Medication Record|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||Drug Programs Policy and Strategy Branch|| || |
| ||Program:||Ontario Public Drug Programs|| || |
| ||Purpose of Form:||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.|| || |
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