where you received/filled the medication, the reason you took the medication, and the approximate dates of use. Medication and Pharmacy (Name Reason for Taking Approximate Date(s) Dosage and Address) Medication of Use IV. INSURANCE INFORMATION 1) Provide the following information for any past or present medical insurance coverage within the last 10 years:
where you received/filled the medication, the reason you took the medication, and the approximate dates of use. Medication and Dosage Pharmacy (Name and Address) Reason for Taking Medication Approximate Date(s) of Use IV. INSURANCE INFORMATION 1) Provide the following information for any past or present medical insurance coverage within the last 10 years:
Plaintiffs_Fact_Sheet.docx