About Your Medications
* Keep a list of all medications and supplements you take.
* Tell your primary care physician (family doctor), behavioral healthcare professional, sleep doctor, and/or pharmacist about all the medicines you take including any over-the-counter medicines, as well as any drug allergies that you may have.
* Ask your pharmacist about side effects and what foods or liquids to avoid while taking medications.
* Read the label, including warnings. Make sure that you receive the medication that was prescribed for you and you know how to use it.
* If the medication looks different than you expected, ask the pharmacist about it.
Medication Information Log
* Use this log to record the medications that you are taking. If you have any concerns about them, then ask your doctor.* Bring this log with you when you go to the doctor.
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DESCRIPTION |
Medication #1 |
Medication #2 |
Medication #N |
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Medication Name and Dosage |
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Name of the doctor who Prescribed the medication |
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Date on the medication bottle |
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Are you still taking this medicine? |
Yes ( ) No ( ) |
Yes ( ) No ( ) |
Yes ( ) No ( ) |
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Are you having any Trouble with this medicine? |
Yes ( ) No ( ) |
Yes ( ) No ( ) |
Yes ( ) No ( ) |
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How many pills do you take at one time? |
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How many times a day do you take your medicine? |
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Problems with the medication |
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List below any questions you might have for your doctor: 1. ____________________________________________________________ 2. ____________________________________________________________ 3. ____________________________________________________________ 4. ____________________________________________________________ Allergies_______________________________________________________ ______________________________________________________________ |
Personal Information:
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Your Name __________________________________________________ Address __________________________________________________ Phone Number ________________________________________________ Primary Care Physician Name_____________________________________ Physician’s Address_____________________________________________ Physician’s Phone Number________________________________________ Emergency Contact _____________________________________________ _____________________________________________________________ |
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June 23rd, 2009 at 3:11 pm
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