• MM slash DD slash YYYY
  • If you would like to transfer all prescriptions, simply check this box.
  • If you would like to selectively transfer your prescriptions, simply start typing in your medications.
  • Rx1 Med Name
  • Rx 1 #
  • Rx2 Med Name
  • Rx 2 #
  • Rx3 Med Name
  • Rx 3 #