PDF VA Form 21-0960J-2
4B. INDICATE ALL TREATMENT MODALITIES USED FOR RECURRENT URINARY TRACT OR KIDNEY INFECTIONS (check all that apply): Long-term drug therapy. If checked, list medications used and indicate dates for courses of treatment over the past 12 months: VA€FORM 21-0960J-2, MAY 2018. PATIENT/VETERAN'S SOCIAL SECURITY NO. ................
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