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IVERMECTIN SCREENING RISK ASSESMENT TOOL
Are you or could you be pregnant or breastfeeding?
Are you prescribed or using any of the following medicatins:
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                                                                    agree to voluntarily obtain ivermectin from this pharmacy under the collaborative pharmacy agreement established by the State of Tennessee TCA   63-10-908 and attest that the above personal information is accurate.

Thank you!

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