Medication Review

Would you like to receive a “medication checkup”? True Health New Mexico would like to assist you in making the most of your pharmacy benefit. Please provide information requested below and we’ll provide recommendations that may save money and/or simplify your medication regimen. Please include over-the-counter products if taken regularly. There is no charge for this service. True Health New Mexico uses a HIPAA-compliant platform and survey vendor to collect your personal responses. We will not share the information you provide in this survey with any other party.  

* 1. Member Name (required):

* 2. Member ID (required):

* 3. Phone Number or E-Mail Address (required):

* 4. Drug Name and Strength and Condition Being Treated: (List each drug and condition in separate boxes. Be sure to include over-the-counter medications and / or herbal supplements.)

* 5. Drug Name and Strength and Condition Being Treated:

* 6. Drug Name and Strength and Condition Being Treated:

* 7. Drug Name and Strength and Condition Being Treated:

* 8. Drug Name and Strength and Condition Being Treated:

* 9. Drug Name and Strength and Condition Being Treated:

* 10. Drug Name and Strength and Condition Being Treated:

* 11. Drug Name and Strength and Condition Being Treated:

* 12. Drug Name and Strength and Condition Being Treated:

* 13. Drug Name and Strength and Condition Being Treated:

* 14. Drug Name and Strength and Condition Being Treated:

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