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Hepatitis B / Pharmacology / Microbiology / Medicine / Doxycycline / Atovaquone/proguanil


Travel Medicine Clinic Name: ____________________________________________________________________________________ SSN: _______________________________________ DOB: ________________________________________ Address: ______
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Document Date: 2014-09-04 12:41:41

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MedicalCondition

depression cancer HTN / Hepatitis A / Polio / traveler’s diarrhea / Allergies / Japanese encephalitis / Hepatitis B / Flu / /

MedicalTreatment

immunizations / /

Position

Physician / Nurse / /

Product

Doxycycline / Malarone / /

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