Tell your doctor and your pharmacist about all medications you are taking (prescription and over-the-counter), before a new prescription is written or dispensed.

You should know the names of all your medications, both prescription and nonprescription (e.g., over-the-counter medicines such as aspirin or cold and allergy remedies, as well as vitamins, herbal remedies, etc.). If you’re seeing more than one doctor make sure to inform each physician of all medications you are taking. It is important your doctors have this information because your new medication may not work well with one or more of those prescription or over-the-counter medicines. Use the Medication Record in this website to list all the prescription drugs and over-the-counter medicines you are currently taking and have taken recently, and make sure to share it with your doctor, pharmacist or other healthcare professional.

To get your list started, ask your pharmacist for a computer printout of all your medications. It’s a good idea to get all your prescriptions filled at the same pharmacy. This way, your pharmacist will have a complete record of all your prescription medicines and can crosscheck for drug interactions. He/she can also check your medication history to see what you have been prescribed for a particular condition in the past. If you have an emergency prescription or mail-order prescription filled elsewhere, bring the bottle/tube to your regular pharmacist the next time you’re in, so it can be entered into your file.

Medication Record

MEDICATIONS YOU TAKE EVERY DAY (complete for each drug)

MEDICATION NAME (Brand and/or generic name) ________________________________

PRESCRIPTION OR NONPRESCRIPTION ________________________________

If Prescription, date it was prescribed and name of prescribing doctor or other healthcare professional
______________________________________________________

DOSAGE (pill size, number of times you take it daily) ________________________________

PURPOSE (why it was prescribed or why you are taking it) ________________________________

HOW TAKEN? (with/without food, time of day) ________________________________

ANY SIDE EFFECTS? (list any side effects you’ve experienced and any action associated with these effects. For example, “stomach upset if not taken with food.”)
______________________________________________________

MEDICATIONS YOU TAKE PERIODICALLY (including medications for allergies, pain, headache, stomach upset, etc.)

MEDICATION NAME (Brand and/or generic name) ________________________________

PRESCRIPTION OR NONPRESCRIPTION ________________________________

If Prescription, date it was prescribed and name of prescribing doctor or other healthcare professional ______________________________________________________

DOSAGE (pill size, number of times you take it daily) ________________________________

PURPOSE (why was it prescribed or why are you taking it) ________________________________

HOW TAKEN? (with/without food, time of day) ________________________________

ANY SIDE EFFECTS? (list any side effects you’ve experienced and any action associated with these effects. For example, “stomach upset if not taken with food.”) ________________________________

MEDICATIONS YOU HAVE TAKEN IN THE PAST (list drugs you’ve taken with success and those you’ve had problems with)

MEDICATION NAME (Brand and/or generic name) ________________________________

PRESCRIPTION OR NONPRESCRIPTION ________________________________

WHEN TAKEN? (month/year) ________________________________

PURPOSE (why was it prescribed or why did you take it) ________________________________

DID IT WORK? ________________________________

LIST ANY SIDE EFFECTS ________________________________

LIST ANY PROBLEMS (include reason and severity of problem. For example, “had allergic reaction”)
______________________________________________________

mEDICATION rECORD