Rx: Please check all that apply and provide refills
Medication / Supply
Nebulizer
Albuterol 0.083% Nebules
Pulmicort 0.25 or 0.5mg Nebules
Ipratropium Br 0.02% Nebules
DuoNeb 0.5-3mg Nebules
Albuterol HFA or Equivalent
Qvar 40/80mcg or Pulmicort 90/180 INH
Flovent 44/110/220mcg INH
Atrovent HFA / Spiriva Handihaler
Breo Ellipta 100/25 or 200/25
Symbicort 80/4.5 or 160/4.5mcg
Advair 100/50 or 250/50 or 500/50
Trelegy Ellipta 100 or 200
Arnuity Ellipta 50 or 100 or 200mcg
Anoro Ellipta 62.5/25mcg
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