FDA-3664.indd PSC Publishing Services

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Specifications	FDA-3664.indd PSC Publishing Services
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Specifications	FDA-3664.indd PSC Publishing Services
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Content	What I’m Using Rx – Brand & generic name; OTC – Name & active ingredients What It Looks Like Color, shape, size, markings, etc. How MuchHow to Use / When to Use Start / Stop Dates Why I’m Using / Notes Who Told Me to Use / How to Contact — Enter ALL prescription (Rx) medicine (include samples), over-the-counter (OTC) medicine, and dietary supplements — Ex:XXXX/xxxxxxxxxx20 mg pill; small, white, round 40 mg; use two 20 mg pills Take orally, 2 times a day, at 8:00 am & 8:00 pm 1-15-11 Lowers blood pressure; check blood pressure once a week; blood test on 4-15-11 Dr. X (800) 555-1212 1 2 3 4 5 6 7 8 DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Be an Active Member of Your Health Care Team My Medicine Record Name (Last, First, Middle Initial): www.fda.gov/Drugs/ResourcesForYou/ucm079489.htm Birth Date (mm/dd/yyyy): These are my medicines as of (Enter date as mm/dd/yyyy): (888) INFO-FDA www.fda.gov/usemedicinesafely FORM FDA 3664 (3/11)Page 1 of 4PSC Publishing Services (301) 443-6740 EF
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Following Datasheets	UCM113945 (1 pages) ucm117684 (34 pages) ucm117686 (33 pages) UCM117701 (18 pages) UCM117706 (14 pages) UCM119207 (24 pages) UCM123687_1 (2 pages) UCM130716 (4 pages) UCM130717 (4 pages) UCM133432 (2 pages)
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