Universal Medication Form
The Universal Medication Form includes a record of your immunizations, allergies, prescribed medications, and any vitamins, herbal supplements or over-the-counter medicines you might be taking.
Keeping an up-to-date copy of the Universal Medication Form in your wallet is one way patients can take a more active role in their health. This form contains valuable information health care providers need when making decisions about your care.
Tips On Using This Form
- Keep a current copy of your Universal Medication Form with you at all times.
- Always take your Universal Medication Form with you to the doctor's office so they can help you keep it up-to-date.
- If you are admitted to the hospital, be sure to share your Universal Medication Form with the registrar. You'll receive a new Universal Medication Form before you go home.
- What is the name of the medicine?
- What is it for?
- What time should I take it?
- How much of it should I take each time?
- How should I take it?
- Should I take this medicine with food?
- How long should I take this medicine?
- What should I do if I miss a dose?
- Are there any side effects? What should I do if I have any reactions to this medicine?
- Is it safe to take this medicine with the other medicines I'm currently taking, including herbs, supplements or over-the-counter drugs?
- Which food, drinks or activities should I avoid while taking this medicine?
Downloads
You can also download the Universal Medication Form as a PDF in English or Spanish.
