Medication Review Form


An example medication review form that was utilized in a program that delivered medication therapy management via videoconferencing to a geographically dispersed, high-need patient group with significant linguistic and cultural barriers to care.


Pharmacy consultants, technology program designers and managers, and field personnel (e.g., community health workers).

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Note that the form collects information about prescription medications as well as over-the-counter (OTC) drugs and medications that may be utilized by a non-American born population group, in this case Cambodian-born Americans.

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