Medication List

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DR. KELLY'S GROTTO
1762 Newbridge Road
Bellmore, NY 11710
(516) 409-OO44
Fax# 516'B04-3392

MEDICATION LIST

List all prescribes and over the counter medications, supplements, herbs, salves and ointments. Remember to update with start and stop date. If exact date is not known, enter approximate date or "(UNKNOWN". If no medications, please write NONE on top line.
Doctor should document that list was reviewed.