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Ruhmann Law Firm


New Mexico 


Valsartan Fillable Intake

  • Date Format: DD slash MM slash YYYY


  • (If Injured Person Is Deceased)

  • Date Format: DD slash MM slash YYYY

  • General Prescribing Questions

  • Have you been diagnosed with any of the following cancers?

    (DECLINE if not dx or dx was prior to 2017)

  • (DECLINE if over age 65 at time of dx)
  • General Prescription and Ingestion History

  • Confounding Factors

  • Recall notification, Pill Bottles and Pills

  • **** Please be sure to save all evidence of Valsartan, including any proof of purchase, receipts, packaging, boxes, etc. ****

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