HTML Preview Printable Pocket Medication List page number 1.
Pocket Medication List (side 1)
Actual size accommodates a wallet much as a credit card. Adapt this template to your practice.
Name:
_
_____________________
_
Home Phone:
_
_______________
_
Cell Phone:
_
________________
_
Address:
_
___________________
_
_
__________________________
_
Allergies:
_
__________________
_
_
__________________________
_
_
__________________________
_
Pharmacy
Name:
_
_____________________
_
Address:
_
___________________
_
_
__________________________
_
Phone #:
_
___________________
_
In Case of Emergency
Name:
_
_____________________
_
Relationship:
_
________________
_
Phone #:
_
___________________
_
Physician: _________________
Phone #: _________________
Keep your Medication Card with you at all
times.
Learn about the medicines you take:
• Why you take them
• Special directions such as activities or foods
and drinks to avoid
• What side effects might occur and what to do
if they occur
Read the label each time you take your
medicine
Inform your physician if you are taking herbal or
other supplements, over the counter, vitamins or
natural remedies.
Update your card whenever your physician
changes your medications
Use one pharmacy so the pharmacist knows all
the medications you are taking.
Medication Card