HTML Preview Printable Personal Medication List page number 1.
PERSONAL MEDICATION LIST FOR:
This medication list may help you keep track of your
medications and how to use them the right way.
•
Use blank rows to add new medications. Then ll in the
dates you started using them.
•
Cross out medications when you no longer use them.
Then write the date and why you stopped using them.
•
Ask your doctors, pharmacists, and other healthcare
providers in your care team to update this list at every
visit.
Keep this list up-to-date with:
prescription medications
over the counter drugs
herbals
vitamins
minerals
If you go to the hospital or emergency room, take this list with you. Share this with your family
or caregivers too.
Date prepared:_______________
Allergies or side effects:
Medication:
How I use it:
Why I use it: Prescriber:
Notes:
Date I started using it: Date I stopped using it:
Why I stopped using it:
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