Daily Tracking and Management Guide
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Name: _________________________ Date: __________________________
Prescribing Provider: _____________________ Phone: _________________________________ Emergency Services: 911 Poison Control: 1-800-222-1222
Week of: ________________
Day | Medications Taken | Side Effects | Cravings (1-10) |
---|---|---|---|
Mon | |||
Tue | |||
Wed | |||
Thu | |||
Fri | |||
Sat | |||
Sun |
_Patient Signature: _____________________ Date: _____________________ Provider Signature: _____________________ Date: _____________________
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