Page 28 - WCCH Digital 2017

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USE THIS HANDY REFERENCE GUIDE! Write the name of each medicine you take, why you take it and when. Add new medicines as they are prescribed and mark o medicines if you no longer take them. Carry this handy reference with you to appointments and to the hospital. Keep your list updated, ask your healthcare professional(s) to assist you.
Medications
Date & Reason Taken
Dose & When Taken
Time(s)
Example: Amoxicillin 250mg
5/12/16 Bladder Infection
1 capsule 3 times a day
9 a.m., 12 p.m., 6 p.m.
Physician:
Phone: Specialty:
Physician:
Phone: Specialty:
Over-The-Counter
o Cold & Flu o Allergy
o Nasal Spray o Aspirin
o Ibuprofen (Advil) o Tylenol
o Vitamins
o Diet Pills
o Antacid
o Sleep Aid
o Laxative
o Nausea/Diarrhea o Other
What are you allergic to?
List all meds, supplements or foods.
Describe symptoms
MEDICINE MINDER