References

For Clinics, Pharmacies & Providers 

Provider Flyer: Information for Clinics and Pharmacies

Notice of Participation Form 

Patient Intake Eligibility Form

Recipient Form for Dispensing (single product)

Recipient Form for Dispensing (multiple products)

Patient Brochure

*Hmong & Arabic translations coming soon!

Are you fluent in another language? Consider donating your time and skills to help RoundtableRx translate our Patient Brochure! Translating our Patient Brochure is one of the many ways RoundtableRx improves access to our program for all Minnesotans. Please contact the RoundtableRx team at info@roundtablerx.org.