Medication List

Name: Family Optometric Group
Address: 1545 West 5th St, Suite 100, Oxnard, CA, 93030, US
Telephone: 805-382-2020

Prescription, over-the-counter, and herbal Medications; and Vitamins.

Please write down pills, injections, drops, etc. you use regularly. Please line through those you no longer use.
Patient
Date
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)
Name of medication Year ( begun/changed) Strength/Amount (dosage) Times per Day Reason for Taking Year (discontinued)

Name of medication	Year ( begun/changed)	Strength/Amount (dosage)	Times per Day	Reason for Taking	Year (discontinued)

Name of medication	Year ( begun/changed)	Strength/Amount (dosage)	Times per Day	Reason for Taking	Year (discontinued)

Name of medication	Year ( begun/changed)	Strength/Amount (dosage)	Times per Day	Reason for Taking	Year (discontinued)

Name of medication	Year ( begun/changed)	Strength/Amount (dosage)	Times per Day	Reason for Taking	Year (discontinued)

Prescription, over-the-counter, and herbal Medications; and Vitamins.

Please write down pills, injections, drops, etc. you use regularly. Please line through those you no longer use.

Office Hours