The Universal Medication Form is available in PDF for download to help you and your family members keep a current record of information about your immunizations, allergies, prescribed medications, and any vitamins, herbal supplements or over-the-counter medicines you take.
Once you print the form, fill in all the blanks that apply. Make sure to include any vitamins, herbal supplements, or over-the-counter medicines. Write neatly so that others can read your form. Keep a copy with you.
Take the form with you to your physician appointments, when you visit the hospital for tests, or when you are admitted to the hospital. It is important to keep your form up-to-date. Ask your physician, nurse and pharmacist to help you keep your form accurate.
Using the Universal Medication Form helps both you and your health care team by:
- Preventing confusion by helping you clearly communicate with your doctor and decreasing the chance that you will forget to mention all of your medications.
- Increasing safety by providing your health care team with accurate information. The form can help prevent prescription duplication or receiving interacting medications. It will also help you communicate any allergies you may have to your health care team.
- Saving time during doctor's appointments and outpatient procedures. When your are asked to list your medications, you can give them a copy of your form.