1. No category

 Dear Patient:
As a Pharmacist at MedicoRx Specialty Pharmacy, I would like to introduce myself and
our Pharmacy Patient Management Program, which includes Medication Therapy Management.
Our exclusive Medication Therapy Management service provides ongoing monitoring of
your complete medical history as well as one-on-one counseling from our knowledgeable and
experienced pharmacists to address your questions and concerns about medications, their side
effects, and any other matters that may arise throughout treatment.
In these consultations, we can help you become more actively involved in your treatment
and answer any questions you may have about your medications. Together, we will work with
your physician to make sure everything is done to meet the goals of therapy and ultimately
improve your health.
Participation in our Patient Management Program is voluntary and free of charge. You
can opt-in and opt-out as well as discontinue the program at any time. If you have questions
about the medications or would like more information about our program, please contact us at
(855) 265 – 7850.
Thank you for your time and I look forward to working with you.
Sincerely,
Anna Brodsky, Pharm D.
MedicoRx Specialty Pharmacy
[
]
Yes, I would like to participate in MedicoRx Specialty Pharmacy MTM Program.
Please contact me to discuss.
[
]
Program.
No, I decline the offer to participate in MedicoRx Specialty Pharmacy MTM
[ ]
I am not sure, please contact me via the telephone to discuss. I would like more
information.
____________________________
_____________________________ _________________
Patient Name
Patient Signature
Date