| INTERVENTION DATE | PATIENT | PROVIDER | PHARMACIST | DRUG | INSTITUTED BY | INTERVENTION | RECOMMENDATION | WAS PROVIDER CONTACTED | PROVIDER CONTACTED | RECOMMENDATION ACCEPTED | AGREE WITH PROVIDER | ORIGINATING PACKAGE | RX # | DIVISION | FINANCIAL COST | OTHER FOR INTERVENTION | OTHER FOR RECOMMENDATION | REASON FOR INTERVENTION | ACTION TAKEN | CLINICAL IMPACT | FINANCIAL IMPACT |
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