My Medication List printable pdf download

My Medication List

My Information

How to Remember

Health Care Provider’s Name: ________________

Name:

_______________________________________

to Take Your Medicine

Phone:__________________________________

Emergency Contact Person’s Name:

_______________________________________

• Take it at the same time as

Pharmacy:_______________________________

something else you do every day,

Phone:__________________________________

like brushing your teeth, walking

Phone:__________________________________

the dog, or watching the news.

Address: ________________________________

Allergies

• Keep medicines in a pill box.

_______________________________________

(to medicines, foods, insect bites or anything else):

_______________________________________

• Use this medication list and keep

it updated.

_______________________________________

• Set your cell phone or watch

Medication List

alarm to remind you to take your

_______________________________________

medicines at the right times.

_______________________________________

• Ask your pharmacy to label your

- Keep It Handy

_______________________________________

medicine bottles in the language

you’d like to read.

_______________________________________

• Have a friend or family member

remind you.

_______________________________________

My Medication List