Universal Medication Form

A Universal Medication Form is a simple list of your medication along with dosing information.

How does this form help you?

Improves communication. When completed, this form provides your doctors and health care providers with necessary information about your medications. When you show them this form they will know exactly what medications need to be taken and when.
Reduces confusion and saves time. By completing this form and presenting it at your appointments or in the Emergency Room, you do not have to remember what medications you are taking; the form will do that for you.

Always keep this form with you.
Take it along to all doctor visits and medical appointments.
Update when changes are made to your medications. If a medication is stopped, draw a line through it and record the date it was stopped.
If help is needed, ask a Physician, Nurse or Pharmacist