Please note that any updates to the Patient Medication Profile should be completed before your next prescription refill. Regular reviews of medication profiles are encouraged semi-annually to ensure safety. Additionally, be aware of any changes in pharmacy policies as they relate to medication management beginning in 2024.

The purpose of the Cresco Family Pharmacy Patient Medication Profile form is to maintain accurate and up-to-date patient medication records. This form allows patients to provide necessary information about their current medications, allergies, and insurance details, ensuring safe prescription practices. The confidential information collected is vital for the pharmacy to offer tailored medication management and address specific health needs.

• 1. Last Name: Patient's last name for identification.
• 2. First Name: Patient's first name.
• 3. M.I.: Middle initial of the patient.
• 4. Address: Street and apartment number.
• 5. City: City of residence.
• 6. State: State of residence.
• 7. Zip Code: Postal code.
• 8. Telephone: Contact number.
• 9. Date of Birth: Patient's birth date.
• 10. Sex: Gender identification.
• 11. Medications Currently Taking: List of all medications being taken.
• 12. Prescription Insurance Information: Details on insurance plan.
• 13. Drug Allergies: Document known drug allergies.
• 14. Pharmacy transferring from: Name of previous pharmacy for transfer.
• 15. Family Members Information: Names and informations of family members needing medication.
• 16. Signature: Patient or guardian's signature for authorization.

Failure to submit this form may result in inaccurate medication records, which can lead to medication errors. It's critical that all information is provided to ensure prescriptions are processed correctly and appropriately. Patients are encouraged to submit the form as soon as possible to avoid any delays in receiving their medications.

• Inaccurate Medication Records: Incorrect or incomplete medication profiles can lead to dangerous drug interactions.
• Delayed Prescription Processing: Not submitting the form may delay the prescription fulfilling process, affecting patient health.
• Insurance Issues: Incorrect information may result in claim denials from insurance providers.

• 1. Starting Medications: Use the form when beginning any new medications.
• 2. Updating Current Medications: Important for keeping your record current and accurate.
• 3. Transferring Prescriptions: Essential for ensuring your medication management is seamless.