Complimentary Medication Log printable pdf download

COMPLIMENTARY MEDICATION LOG

The chart on the following page can help you keep track of when you take your medications over the course of a few weeks.

It is very important to take all your medications as prescribed by your healthcare team, even if you feel well or if your symptoms improve.

It can sometimes be difficult to remember to take every single dose at the correct time, especially if you have to take more than one kind

of medication each day.

Be sure to bring the completed medication log to your next appointment and discuss it with your doctor. It can help show your doctor

whether medications were taken as prescribed as well as any challenges you may be having. When these issues are clear, your doctor can

see the big picture of the medications that you take, make changes (if necessary), and offer you helpful tips and ideas to stay on track.

1. To complete your log you will need:

• All of your prescription medication bottles

• A copy of the medication log from your doctor

2. Fill in the information at the top of the log:

• Your name

• Week start date: the first day of the week that you are tracking (example: Week of 3/15/12)

• Your doctor’s name

• The week number in the blue box in the top left corner; if this is the first week you are filling out the log, then that would be Week 1

(Week 2 would be recorded on the next sheet, Week 3 on the one after that, and so on)

3. Set up your log for the week. For each of your prescription medications, write down:

• Medication: name of the medicine

• Dose: how much you take each time (usually listed in milligrams)

• Frequency: how often you take this medication each day (example: morning and night, with dinner, etc.)

• Date: put a date in each of the boxes along the top of the chart (example: 3/15, 3/16, etc.)

4. Fill out your log every time you take a medication by writing down:

• The time of day each dose was taken

• NOTE: leave the “Dose 2 taken” and/or “Dose 3 taken” lines blank if you only take that particular medication once or twice a day

• If you miss a dose, write “missed” or “forgot” in the box

5. Use the notes section at the bottom to explain reasons for any missed doses or any other information you think is important.

6. Track your medications every day, and remember to bring the completed log with you to your next appointment!

Complimentary Medication Log