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Humanes B, Lazaro A, Camano S, Moreno-Gordaliza E, Lazaro JA, Blanco-Codesido M, et al

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Name of owner Name and species of the animal Name of drug Strength of the drug Dosage form of the drug Quantity of the drug Directions of use Date of issuance Vet's name with signature and state license number Number of refills authorized A prescription may be transmitted by facsimile (fax) to the pharmacy only by the prescribing veterinarian