Verify Patient

Enter patient first and last name followed by the
patient date of birth to verify and locate the patient.

First Name *
Please enter a First Name.
Last Name *
Please enter a Last Name.
Date of Birth(mm/dd/yyyy) *
Please enter a Date of Birth.
Phone Number *
Please enter a Last Name.

Verify Patient

Enter patient Last Name followed by the
patient date of birth to verify and locate the patient.

Last Name *
Please enter a Last Name.
Date of Birth(mm/dd/yyyy) *
Please enter a Date of Birth.

Select Forms

Select the forms you would like the patient to
complete and click confirm to go into kiosk mode.

{{Loaderpercnt.toFixed(0)}}%done... Step {{cntpage}}: {{TopSectionTitle}}

Form {{CurrFormId}} Page {{PageNumber-1}}

{{field.Name.replace('dd/mm/yyyy','') + (field.GetFieldSetting('Required') ? '': '')}} {{field.Name.toLowerCase().includes('date') ? '(MM/DD/YYYY)' :''}}{{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}} Please enter a {{field.Name.replace('dd/mm/yyyy','')}}.

{{field.Name + (field.GetFieldSetting('Required') ? '': '')}} (MM/DD/YYYY) {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}} Please enter a {{field.Name}}.

{{field.Name + (field.GetFieldSetting('Required') ? '': '')}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
{{field.Name}} Please enter a {{field.Name}}. (success)

{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.Name}}.

{{field.Name}} (MM/DD/YYYY){{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a valid {{field.Name}} (MM/DD/YYYY). (success)

{{field.Name}} (MM/DD/YYYY){{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a valid {{field.Name}} (MM/DD/YYYY). (success)

{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a valid {{field.Name}}. (success)

{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.Name}}. (success)
{{field.SubField1}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.SubField1}}. (success)

{{field.SubField2}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.SubField2}}. (success)
{{field.SubField3}} (MM/DD/YYYY){{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a valid {{field.SubField3}} (MM/DD/YYYY). (success)
{{field.SubField4}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
{{Gender}}
Please enter a {{field.SubField4}}.

Male

Female

Other

Them/They

Zee/Zer
(success)
{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.Name}}. (success)

{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.Name}}. (success)

{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.Name}}. (success)

{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.Name}}. (success)

{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.Name}}. (success)

{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.Name}}. (success)
{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
{{State}}
Please enter a {{field.Name}}.
- Alabama (AL)
- Alaska (AK)
- Arizona (AZ)
- Arkansas (AR)
- California (CA)
- Colorado (CO)
- Connecticut (CT)
- Delaware (DE)
- Florida (FL)
- Georgia (GA)
- Hawaii (HI)
- Idaho (ID)
- Illinois (IL)
- Indiana (IN)
- Iowa (IA)
- Kansas (KS)
- Kentucky (KY)
- Louisiana (LA)
- Maine (ME)
- Maryland (MD)
- Massachusetts (MA)
- Michigan (MI)
- Minnesota (MN)
- Mississippi (MS)
- Missouri (MO)
- Montana (MT)
- Nebraska (NE)
- Nevada (NV)
- New Hampshire (NH)
- New Jersey (NJ)
- New Mexico (NM)
- New York (NY)
- North Carolina (NC)
- North Dakota (ND)
- Ohio (OH)
- Oklahoma (OK)
- Oregon (OR)
- Pennsylvania (PA)
- Rhode Island (RI)
- South Carolina (SC)
- South Dakota (SD)
- Tennessee (TN)
- Texas (TX)
- Utah (UT)
- Vermont (VT)
- Virginia (VA)
- Washington (WA)
- West Virginia (WV)
- Wisconsin (WI)
- Wyoming (WY)
(success)
{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
{{OptOutSMS}}
Please enter a {{field.Name}}.
- Yes "I do" consent to text communication
- I "do not" consent to text communication
(success)
{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Please enter a {{field.Name}}. (success)

* {{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}

{{field.fieldType}}

{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}

{{field.fieldExplainer}}
{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}} Select an Individual
- {{indi.FieldTxtValue}}
- Other
{{field.OtherType}}
{{field.fieldExplainer}}
{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}} Select an Individual
- {{indi.FieldTxtValue}}
- Other
{{field.OtherType}}
{{field.fieldExplainer}}
{{field.Name}}
{{field.fieldType}} *
{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
{{Gender}}
Please enter a {{field.Name}}.
- Male
- Female
- Other
- Them/They
- Zee/Zer
(success)
{{field.Name}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
{{MartialStatus}}
Please enter a {{field.Name}}.
- Single
- Married
- Child
- Widowed
- Divorced
(success)
{{field.Other}}

Yes

No
{{field.Name}}
Select an Individual

{{indi.FieldTxtValue}}

Other

{{field.fieldType}}
{{field.fieldType}}
{{field.Name}}

{{indi.FieldTxtValue}}

{{field.fieldType}}
{{field.fieldType}}
{{field.Other}}

Yes

No

DK
{{field.Name}}
Select an Individual

{{indi.FieldTxtValue}}

Other

{{field.fieldType}}
{{field.fieldType}}
{{field.Name}}

{{indi.FieldTxtValue}}

{{field.fieldType}}
{{field.fieldType}}
{{field.Other}}

Yes

No
{{field.Name}}
Select an Individual

{{indi.FieldTxtValue}}

Other

{{field.fieldType}}
{{field.fieldType}}
{{field.Name}}

{{indi.FieldTxtValue}}

{{field.fieldType}}
{{field.fieldType}}
{{field.Other}}

Yes

No
{{field.fieldType}}
Select an Individual

No Known Allergies

Acetaminophen

Acrylic

Anesthetics

Aspirin

Barbiturates

Codeine

Erythromycin

Fluoride

Ibuprofen

Iodine

Local anesthetic

Metals

Penicillin

Sedatives

Sulfa

Tetracycline

Latex

{{txtMulti}}

Other

{{field.OtherType}}
{{field.fieldType}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Select an Individual

No Known Allergies

Acetaminophen

Acrylic

Anesthetics

Aspirin

Barbiturates

Codeine

Erythromycin

Fluoride

Ibuprofen

Iodine

Local anesthetic

Metals

Penicillin

Sedatives

Sulfa

Tetracycline

Latex

{{txtMulti}}

Other

{{field.OtherType}}
{{field.Other}}

Yes

No
{{field.fieldType}}
Select an Individual

No Known Allergies

Acetaminophen

Acrylic

Anesthetics

Aspirin

Barbiturates

Codeine

Erythromycin

Fluoride

Ibuprofen

Iodine

Local anesthetic

Metals

Penicillin

Sedatives

Sulfa

Tetracycline

Latex

{{txtMulti}}

Other

{{field.OtherType}}
{{field.Other}}

Yes

No
{{field.fieldType}}
Select an Individual

No Known Medical Conditions

Acid reflux (GERD)

ADD

ADHD

Alcoholism/Chemical dependency

Allergies

Anemia

Anxiety

Arthirits

Artifical Joints

Asthma

Autism

Autoimmune Disease

Back problems

Blood Disease/Disorder

Blood Transfusion

Bone Disease

Bulimia

Cancer/Chemotherapy

Cold/Sores

Convulsions/Seizures

COPD

Currently Pregnant

Cystic Fibrosis

Dementia

Depression

Diabetes

Dry Mouth

Epilepsy/Seizures/Convulsions

Excessive Bleeding

Fainting/Dizziness

Gallbladder Disease

Genetic Disorders

Glaucoma

Head Injuries

Hearing Impaired

Heart Attack

Heart Disease

Heart Murmur

Heart Surgery

Hepatitis B

Hepatitis C

High Blood Pressure

High Cholesterol

Hip or Joint Replacement

History of Alcohol Abuse

History of Drug Abuse

HIV

HPV

Immune Disorder

Insomnia

Jaundice

Kidney Dialysis

Kidney Disease

Latex Sensitivity

Low Blood Pressure

Migraines

Mitral Valve Prolapse

Multiple Sclerosis

Neck and Back Problems

Osteoporosis

Pacemaker

Pre-Med Prior to Treatment

Psychiatric Care

PTSD

Radiation Treatment

Respiratory Problems/Disorders

Rheumatric Fever

Sinus Problems

Sleep Apnea

Snoring

Stomach Ulcers

Stomach/GI Disorders

Stroke

Thyroid Disease/Problems

TMJ/TMD

Tobacco, Vape, Dip usage(past or current usage)

Tuberculosis

Tumors or Growths

Venereal Disease

Other

{{field.OtherType}}
{{field.fieldType}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Select an Individual

No Known Medical Conditions

Acid reflux (GERD)

ADD

ADHD

Alcoholism/Chemical dependency

Allergies

Anemia

Anxiety

Arthirits

Artifical Joints

Asthma

Autism

Autoimmune Disease

Back problems

Blood Disease/Disorder

Blood Transfusion

Bone Disease

Bulimia

Cancer/Chemotherapy

Cold/Sores

Convulsions/Seizures

COPD

Currently Pregnant

Cystic Fibrosis

Dementia

Depression

Diabetes

Dry Mouth

Epilepsy/Seizures/Convulsions

Excessive Bleeding

Fainting/Dizziness

Gallbladder Disease

Genetic Disorders

Glaucoma

Head Injuries

Hearing Impaired

Heart Attack

Heart Disease

Heart Murmur

Heart Surgery

Hepatitis B

Hepatitis C

High Blood Pressure

High Cholesterol

Hip or Joint Replacement

History of Alcohol Abuse

History of Drug Abuse

HIV

HPV

Immune Disorder

Insomnia

Jaundice

Kidney Dialysis

Kidney Disease

Latex Sensitivity

Low Blood Pressure

Migraines

Mitral Valve Prolapse

Multiple Sclerosis

Neck and Back Problems

Osteoporosis

Pacemaker

Pre-Med Prior to Treatment

Psychiatric Care

PTSD

Radiation Treatment

Respiratory Problems/Disorders

Rheumatric Fever

Sinus Problems

Sleep Apnea

Snoring

Stomach Ulcers

Stomach/GI Disorders

Stroke

Thyroid Disease/Problems

TMJ/TMD

Tobacco, Vape, Dip usage(past or current usage)

Tuberculosis

Tumors or Growths

Venereal Disease

Other

{{field.OtherType}}
{{field.Other}}

Yes

No
{{field.fieldType}}
Select an Individual

No Known Medical Conditions

Acid reflux (GERD)

ADD

ADHD

Alcoholism/Chemical dependency

Allergies

Anemia

Anxiety

Arthirits

Artifical Joints

Asthma

Autism

Autoimmune Disease

Back problems

Blood Disease/Disorder

Blood Transfusion

Bone Disease

Bulimia

Cancer/Chemotherapy

Cold/Sores

Convulsions/Seizures

COPD

Currently Pregnant

Cystic Fibrosis

Dementia

Depression

Diabetes

Dry Mouth

Epilepsy/Seizures/Convulsions

Excessive Bleeding

Fainting/Dizziness

Gallbladder Disease

Genetic Disorders

Glaucoma

Head Injuries

Hearing Impaired

Heart Attack

Heart Disease

Heart Murmur

Heart Surgery

Hepatitis B

Hepatitis C

High Blood Pressure

High Cholesterol

Hip or Joint Replacement

History of Alcohol Abuse

History of Drug Abuse

HIV

HPV

Immune Disorder

Insomnia

Jaundice

Kidney Dialysis

Kidney Disease

Latex Sensitivity

Low Blood Pressure

Migraines

Mitral Valve Prolapse

Multiple Sclerosis

Neck and Back Problems

Osteoporosis

Pacemaker

Pre-Med Prior to Treatment

Psychiatric Care

PTSD

Radiation Treatment

Respiratory Problems/Disorders

Rheumatric Fever

Sinus Problems

Sleep Apnea

Snoring

Stomach Ulcers

Stomach/GI Disorders

Stroke

Thyroid Disease/Problems

TMJ/TMD

Tobacco, Vape, Dip usage(past or current usage)

Tuberculosis

Tumors or Growths

Venereal Disease

Other

{{field.OtherType}}
{{field.Other}}

Yes

No
{{field.fieldType}}
Select an Individual

No Known Medications

Acid Reflux

ADHD

Mixed amphetamine salts (Adderall)

Dexmethylphenidate (Focalin) Methylphenidate (Ritalin)

Lisdexamfetamine (Vyvanse) Guanfacine (Intuniv)

Clonidine (Kapvay) Atomexetine (Strattera)

Allergy

Claritin

Flonase

Singular

Bentolin

Zyrtech

Asthma

Albuterol Fluticasone

(Flovent) Montelukast (Singulair)

Antibiotics

Amoxicillin

Clindamycin

Coxycycline

Doxycycline

Tetracycline

Zithromax

Antidepressant

Adderall

Ambien (Zolpidem)

Celexa (Citalproam)

Cymbalta (Duloxentine)

Effexor (Venlafaxine)

Lexapro (Escitalopram)

Neurontin (Gabapentin)

Oleptro (Trazodone)

Prozac (Fluoxetine)

Xanax (Alprazolam)

Wellbutrin (Buproprion)

Zolof (Sertraline)

Arthritis

Ibuprofen (Advil, Motrin)

Naproxen (Aleve)

Celecoxib (Celebrex)

Diclofenac (Voltaren)

Methotrexate

Hydroxychloroquine (Plaquenil)

Sulfasalazine (Azulfidine)

Leflunomide (Arava)

Adalimumab (Humira)

Etanercept (Enbrel)

Infliximab (Remicade)

Certolizumab pegol (Cimzia)

Golimumab (Simponi)

Prednisone

Dexamethasone

Methylprednisolone

Acetaminophen (Tylenol)

Tramadol (Ultram)

Blood Pressure

Avapro (Irbesartan)

Coreg (Carvedilol)

Coumadin (Warfarin)

Crestor (Rosuvastatin)

Klor-Con (Potassium Chloride)

Lasic (Furosemide)

Lipitor (Atorvastatin Calcium)

Lopressor (Metoprolol)

Losartan (Cozaar)

Metformin (Gluophage)

Microzide (Hydrochlorothiazide)

Plavix (Clopidogrel)

Pravachol (Pravastatin)

Prinivil (Lisinopril)

Tenormin (Atenolol)

Toprol XL (Metoprolol)

Tricor (Fenofibrate)

Zestoretic (Lisinopril)

Zocor (Simvastatin)

Cholesterol

Avapro (Irbesartan)

Coreg (Carvedilol)

Coumadin (Warfarin)

Crestor (Rosuvastatin)

Klor-Con (Potassium Chloride)

Lasic (Furosemide)

Lipitor (Atorvastatin Calcium)

Lopressor (Metoprolol)

Losartan (Cozaar)

Metformin (Gluophage)

Microzide (Hydrochlorothiazide)

Plavix (Clopidogrel)

Pravachol (Pravastatin)

Prinivil (Lisinopril)

Tenormin (Atenolol)

Toprol XL (Metoprolol)

Tricor (Fenofibrate)

Zestoretic (Lisinopril)

Zocor (Simvastatin)

Diabetes

Avapro (Irbesartan)

Coreg (Carvedilol)

Coumadin (Warfarin)

Crestor (Rosuvastatin)

Dapagliflozin

Exenatide

Glipizide

Klor-Con (Potassium Chloride)

Lasic (Furosemide)

Lipitor (Atorvastatin Calcium)

Lopressor (Metoprolol)

Losartan (Cozaar)

Metformin (Gluophage)

Microzide (Hydrochlorothiazide)

Pioglitazone

Plavix (Clopidogrel)

Pravachol (Pravastatin)

Prinivil (Lisinopril)

Sitaglitptin

Tenormin (Atenolol)

Toprol XL (Metoprolol)

Tricor (Fenofibrate)

Zestoretic (Lisinopril)

Zocor (Simvastatin)

Osteoporosis

Pain Medication

Aspirin

Codeine

Ibprofen

Tramadol

Thyroid

Other

{{field.OtherType}}
{{field.fieldType}} {{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}}
Select an Individual

No Known Medications

Acid Reflux

ADHD

Mixed amphetamine salts (Adderall)

Dexmethylphenidate (Focalin) Methylphenidate (Ritalin)

Lisdexamfetamine (Vyvanse) Guanfacine (Intuniv)

Clonidine (Kapvay) Atomexetine (Strattera)

Allergy

Claritin

Flonase

Singular

Bentolin

Zyrtech

Asthma

Albuterol Fluticasone

(Flovent) Montelukast (Singulair)

Antibiotics

Amoxicillin

Clindamycin

Coxycycline

Doxycycline

Tetracycline

Zithromax

Antidepressant

Adderall

Ambien (Zolpidem)

Celexa (Citalproam)

Cymbalta (Duloxentine)

Effexor (Venlafaxine)

Lexapro (Escitalopram)

Neurontin (Gabapentin)

Oleptro (Trazodone)

Prozac (Fluoxetine)

Xanax (Alprazolam)

Wellbutrin (Buproprion)

Zolof (Sertraline)

Arthritis

Ibuprofen (Advil, Motrin)

Naproxen (Aleve)

Celecoxib (Celebrex)

Diclofenac (Voltaren)

Methotrexate

Hydroxychloroquine (Plaquenil)

Sulfasalazine (Azulfidine)

Leflunomide (Arava)

Adalimumab (Humira)

Etanercept (Enbrel)

Infliximab (Remicade)

Certolizumab pegol (Cimzia)

Golimumab (Simponi)

Prednisone

Dexamethasone

Methylprednisolone

Acetaminophen (Tylenol)

Tramadol (Ultram)

Blood Pressure

Avapro (Irbesartan)

Coreg (Carvedilol)

Coumadin (Warfarin)

Crestor (Rosuvastatin)

Klor-Con (Potassium Chloride)

Lasic (Furosemide)

Lipitor (Atorvastatin Calcium)

Lopressor (Metoprolol)

Losartan (Cozaar)

Metformin (Gluophage)

Microzide (Hydrochlorothiazide)

Plavix (Clopidogrel)

Pravachol (Pravastatin)

Prinivil (Lisinopril)

Tenormin (Atenolol)

Toprol XL (Metoprolol)

Tricor (Fenofibrate)

Zestoretic (Lisinopril)

Zocor (Simvastatin)

Cholesterol

Avapro (Irbesartan)

Coreg (Carvedilol)

Coumadin (Warfarin)

Crestor (Rosuvastatin)

Klor-Con (Potassium Chloride)

Lasic (Furosemide)

Lipitor (Atorvastatin Calcium)

Lopressor (Metoprolol)

Losartan (Cozaar)

Metformin (Gluophage)

Microzide (Hydrochlorothiazide)

Plavix (Clopidogrel)

Pravachol (Pravastatin)

Prinivil (Lisinopril)

Tenormin (Atenolol)

Toprol XL (Metoprolol)

Tricor (Fenofibrate)

Zestoretic (Lisinopril)

Zocor (Simvastatin)

Diabetes

Avapro (Irbesartan)

Coreg (Carvedilol)

Coumadin (Warfarin)

Crestor (Rosuvastatin)

Dapagliflozin

Exenatide

Glipizide

Klor-Con (Potassium Chloride)

Lasic (Furosemide)

Lipitor (Atorvastatin Calcium)

Lopressor (Metoprolol)

Losartan (Cozaar)

Metformin (Gluophage)

Microzide (Hydrochlorothiazide)

Pioglitazone

Plavix (Clopidogrel)

Pravachol (Pravastatin)

Prinivil (Lisinopril)

Sitaglitptin

Tenormin (Atenolol)

Toprol XL (Metoprolol)

Tricor (Fenofibrate)

Zestoretic (Lisinopril)

Zocor (Simvastatin)

Osteoporosis

Pain Medication

Aspirin

Codeine

Ibprofen

Tramadol

Thyroid

Other

{{field.OtherType}}
{{field.Other}}

Yes

No
{{field.fieldType}}
Select an Individual

No Known Medications

Acid Reflux

ADHD

Mixed amphetamine salts (Adderall)

Dexmethylphenidate (Focalin) Methylphenidate (Ritalin)

Lisdexamfetamine (Vyvanse) Guanfacine (Intuniv)

Clonidine (Kapvay) Atomexetine (Strattera)

Allergy

Claritin

Flonase

Singular

Bentolin

Zyrtech

Asthma

Albuterol Fluticasone

(Flovent) Montelukast (Singulair)

Antibiotics

Amoxicillin

Clindamycin

Coxycycline

Doxycycline

Tetracycline

Zithromax

Antidepressant

Adderall

Ambien (Zolpidem)

Celexa (Citalproam)

Cymbalta (Duloxentine)

Effexor (Venlafaxine)

Lexapro (Escitalopram)

Neurontin (Gabapentin)

Oleptro (Trazodone)

Prozac (Fluoxetine)

Xanax (Alprazolam)

Wellbutrin (Buproprion)

Zolof (Sertraline)

Arthritis

Ibuprofen (Advil, Motrin)

Naproxen (Aleve)

Celecoxib (Celebrex)

Diclofenac (Voltaren)

Methotrexate

Hydroxychloroquine (Plaquenil)

Sulfasalazine (Azulfidine)

Leflunomide (Arava)

Adalimumab (Humira)

Etanercept (Enbrel)

Infliximab (Remicade)

Certolizumab pegol (Cimzia)

Golimumab (Simponi)

Prednisone

Dexamethasone

Methylprednisolone

Acetaminophen (Tylenol)

Tramadol (Ultram)

Blood Pressure

Avapro (Irbesartan)

Coreg (Carvedilol)

Coumadin (Warfarin)

Crestor (Rosuvastatin)

Klor-Con (Potassium Chloride)

Lasic (Furosemide)

Lipitor (Atorvastatin Calcium)

Lopressor (Metoprolol)

Losartan (Cozaar)

Metformin (Gluophage)

Microzide (Hydrochlorothiazide)

Plavix (Clopidogrel)

Pravachol (Pravastatin)

Prinivil (Lisinopril)

Tenormin (Atenolol)

Toprol XL (Metoprolol)

Tricor (Fenofibrate)

Zestoretic (Lisinopril)

Zocor (Simvastatin)

Cholesterol

Avapro (Irbesartan)

Coreg (Carvedilol)

Coumadin (Warfarin)

Crestor (Rosuvastatin)

Klor-Con (Potassium Chloride)

Lasic (Furosemide)

Lipitor (Atorvastatin Calcium)

Lopressor (Metoprolol)

Losartan (Cozaar)

Metformin (Gluophage)

Microzide (Hydrochlorothiazide)

Plavix (Clopidogrel)

Pravachol (Pravastatin)

Prinivil (Lisinopril)

Tenormin (Atenolol)

Toprol XL (Metoprolol)

Tricor (Fenofibrate)

Zestoretic (Lisinopril)

Zocor (Simvastatin)

Diabetes

Avapro (Irbesartan)

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Osteoporosis

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Aspirin

Codeine

Ibprofen

Tramadol

Thyroid

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{{field.SubField2}} {{(field.Settings[0].Options[1].Name=='Required Subscriber Name' && field.Settings[0].Options[1].Value == true ? '*' : '')}}
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{{field.SubField3}} {{(field.Settings[0].Options[2].Name=='Required Subscriber SSN' && field.Settings[0].Options[2].Value == true ? '*' : '')}}
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{{field.SubField4}} {{(field.Settings[0].Options[3].Name=='Required Subscriber Date of Birth' && field.Settings[0].Options[3].Value == true ? '*' : '')}}
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{{field.Name.replace('dd/mm/yyyy','') + (field.GetFieldSetting('Required') ? '': '')}} {{field.Name.toLowerCase().includes('date') ? '(MM/DD/YYYY)' :''}}{{(field.Settings[0].Options[0].Name=='Required' && field.Settings[0].Options[0].Value == true ? '*' : '')}} Please enter a {{field.Name.replace('dd/mm/yyyy','')}}.

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CarolinasDentist Cary

2032 Renaissance Park Place ,Cary, North Carolina 27513

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CarolinasDentist Cary

2032 Renaissance Park Place ,Cary, North Carolina 27513

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CarolinasDentist Cary

2032 Renaissance Park Place ,Cary, North Carolina 27513

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CarolinasDentist Cary

2032 Renaissance Park Place ,Cary, North Carolina 27513

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