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Universal Medication Form

   

What's a universal medication form?

This form helps you take an inventory and provide your health care professionals with a current list of ALL of your medicines. It is important for your physician to know any herbals, vitamins, or over-the-counter medicines you may be taking in addition to prescriptions.

Download the Universal Medication Form

Remember These Important Tips

  1. Always keep this form with you. You may want to fold it and keep it in your wallet along with your driver’s license so it will be available in case of an emergency.
  2. Include all of the medicines you are taking and list all of your drug allergies. 
  3. Bring this form to all doctor appointments, tests and hospital visits.
  4. Record all changes made to your medicines. If you stop taking a certain medicine, draw a line through it and write the date it was stopped. If help is needed, ask your doctor, durse, pharmacist or family member to help you to keep it up-to-date.
  5. Include the name(s) of any doctors who told you to take the medicine(s). You may also record the reason you are taking the medicine (Examples: high blood pressure, high blood sugar, high cholesterol).
  6. Fill out a new form when you leave the hospital.Since many changes are often made after a hospital stay, a new form should be filled out. When you return to your doctor, take your new form with you. This will keep everyone up-to-date.