Page 27 - CHI ST LUKES VINTAGE HOSPITAL PATIENT GUIDE

Handy Reference: Medications You Are Currently Taking YOUR MEDICINE MINDER

List all medications you are currently taking (prescription, over-the-counter and vitamin supplements), their name, strength, and
dosage. (Example: Haldol-25mg twice a day, Aspirin-12mg daily, Albuterol Inhaler as needed, Zyrtec-10mg as needed, Calcium)

Name Of Medication Date Started Taking Dose (How Much You Take) When You Take Reason For Taking

What Are You Allergic To? List Any Medications, Supplements or Foods Describe Symptoms

Medications You Need To Take After Leaving The Hospital

Use this Medicine Minder to record the names, dosages, and instructions for your new medications you will need to take when you
leave the hospital. This is your opportunity to ask your care provider any questions you may have about your medications.

Name Of Medication Reason For Taking Dose (How Much When To How to Take It? (on an empty stomach,
To Take) Take It? with food, etc.)

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