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This medication eszopiclone consent is for a period effective immediately and not to exceed fifteen (15) months from the date of my signature .
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eszopiclone Obtained by – PRINT – Staff Name Written Consent Received Obtained from – PRINT – Parent / Guardian (POA-HC) Name .
DEPARTMENT OF HEALTH SERVICES Division of Care lunesta hong kong eszopiclone 3 mg reviews lunesta side effects hair loss lunesta tolerance side and Treatment Services F-24277 (09/2016) STATE OF WISCONSIN 42 CFR483 . 31(3)(o) DHS eszopiclone 94 . eszopiclone 03 & 94 . 420(a)(2) DHS lunesta names lunesta taste in mouth eszopiclone south africa zaleplon and eszopiclone lunesta drug 134 . 09 §§ eszopiclone 51 . 61(1)(g) lunesta lethal dose lunesta xanax generic to lunesta eszopiclone intermediates lunesta weight gain & (h) INFORMED CONSENT FOR MEDICATION Dosage and / or Side Effect information last revised on 08/16/2016 Completion of this form is voluntary .
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