Medication List
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1
2Pharmacy Tel:01 2774518 Fax: 01 2773790
Community
pharmacy
Address
PATIENT’S NAME:
Telephone
My Medication List
Dear Patient,
Remember, your community pharmacy is an excellent
-
When you attend St Vincent’s University Hospital, it is important that
source of any kind of INFORMATION about your
our doctors and other healthcare workers know exactly which
medications.
medications you are taking. This will improve your MEDICATION SAFETY
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Take your medicines EXACTLY AS DIRECTED by your doctor
by avoiding any potential confusion or errors about your medication.
SVUH Pharmacy Department, Version 1, August 2009
or as instructed on the label. This is important for them to
work properly.
Please take the time to complete this form. If you are unsure of all of
If you experience any SIDE-EFFECTS which you think may
your medications, your COMMUNITY PHARMACIST or your GP are the best
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be caused by your medication, please tell the doctor.
people to help you. If the form is not big enough, ask them to copy it
Keep your medicines in their original labelled containers
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before filling it in, or download a blank form from
because
they may deteriorate if unpacked
n_List.htm
.See overleaf for a list of the kind of items you should
the labels contain important instructions
include.*
we may need to be able to identify them.
Keep all your medications at room temperature, except
Try to update this list each time you are to attend the hospital. There is
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those that need to be kept in the fridge.
lots of space for extra information. Cross out any medications that you
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Keep all your medications safely LOCKED away where
no longer use. If you are to be admitted, bring this list and bring all of
CHILDREN cannot reach them: your medications could
your medications in with you, in their original labelled containers.
HARM them, if accidentally taken.
Do not share your medications with anyone else: they
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If you attend a particular community pharmacy, please write their name,
have been prescribed for YOU individually, based on YOUR
address and contact details on the back. This will allow us to clarify any
needs.
issues that might arise. Ask them for any information booklets they
might have about knowing your medicines or about medication safety.
This list should be maintained by the patient and brought into hospital
Thank-you for helping us with this important PATIENT SAFETY initiative.
for all attendances. Do NOT file original in patient’s Healthcare Record.
Please list your medications overleaf
(SVUH Pharmacy Department, Version 1, Feb 2010.)
If you find this card, please contact me at _______________________________
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