My Medication List
Instructions on Using and Completing the Form
- Always keep this form with you.
- Take this form to all doctor visits and all medical testing (lab, x-ray, MRI, CT, etc.). Take this form to all pre-assessment visits for admission or surgery and all hospital visits (ER, in-patient admission, out-patient visits).
- Update this form as changes are made to your medications. When a medication is stopped, draw a line through it and record the date it was stopped. If help is needed, ask a physician, nurse, or pharmacist to help you fill out this form.
- Tell your family, friends and neighbors about the benefits of using this form.
- When you are discharged from the hospital, you will get an updated list of your medications. This will be reviewed with you and you will be given a copy. When you return to your doctor, take your updated list with you. Always keep this form with you. This will keep everyone up-to-date on your medications.
By using a current medication list and keeping it updated, you can:
- Reduce confusion and save time. It helps you remember your medications.
- Improve communications. Provide doctors, health care providers and institutions with a current list of all of your medications. Lets the patient and/or family member know exactly what medications are to be taken and when.
- Improve MEDICATION SAFETY. Medication interactions and duplications can be detected and corrected.