0045- 0000-00 · N D C 5 0 5 8 0 -XXX-X X Nasal C ongestion Runny Nose Itchy Nose Sneezing...

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---------------------------------------------------------------------------------------------------------This is a representation of an electronic record that was signedelectronically and this page is the manifestation of the electronicsignature.---------------------------------------------------------------------------------------------------------/s/----------------------------------------------------

THERESA M MICHELE03/23/2015

Reference ID: 3720231