CRIMSONBOW SICKLE CELL INITIATIVE presents Project Medicate A Warrior (Intensive Medication for sickle cell Warriors 2018)
GENOTYPE (come with proof)
HOSPITAL (Name and Address)
PRESCRIBED DRUG(s) Yes/No (come with prescription)
DRUGS AND DOSAGE
TERMS AND CONDITIONS
Person must be available to pick up drugs monthly or quarterly from Ikeja, Lagos state. Must also come with the afore stated proof required to pick up their medications.
I, THE ABOVE NAMED INDIVIDUAL CERTIFY UPON SUBMITTING THIS FORM, THAT THE WRITTEN DRUGS ABOVE ARE PRESCRIBED BY THE DOCTOR STATED ABOVE ARE REQUIRED FOR THE IMPROVEMENT OF MY HEALTH.
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