The Universal Medication Form
How does this form help you?
This form helps you and your family members remember all of the medicines that you are taking.
It provides your doctor(s) and others with a current list of all of your medicines. Doctors need to know the all the over-the-counter medicine you take, including vitamins and herbal supplements. It helps you avoid potential problems with medication interactions.
What medications do I list on the form?
List all current medications, including prescriptions, over-the-counter drugs, vitamins and herbal remedies.
What do I do with the form once I have filled it out?
Keep it in your wallet or purse at all times so that it is readily available in case of emergency. Take the form with you to all healthcare visits and show it to all of your healthcare providers.
Why should I use this form?
It will save you time at the doctor's office. When your are asked to list your medications, you can give them the form.
It will reduce confusion by helping you communicate with your doctor and decrease the chance that you will forget to mention all of your medications.
It will increase your medication safety because your providers will have more accurate infomation and it will help prevent them from prescribing duplicate medications or interacting medications.
It also helps imporve your medication safety by communicating your allergies to your providers.
What if my doctor changes my prescriptions?
You must update your form. Ask your provider or your pharmacist to help you update your form. If you fill out a new form, discard the old one.
Who should use the Universal Medication Form?
Anyone taking more than one medication each day should use this form.
Universal Medication Form - English
Universal Medication Form - Spanish
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