Lifewise My Medication List

My Medication List

Use the chart below to create a record of your medications. It is important to keep it up-to-date.

Remember to list over-the-counter (non-prescription) medicines and herbal supplements too.

Review it once a year with your health care provider.

________________________________________________

Name

Ask your doctor to explain each medicine:

•

Why you are taking it?

•

What are the side effects?

•

How long you can expect to take it?

NAME OF MEDICINE

DOSE

DIRECTIONS FOR USE

WHY TAKING IT?

Example: Synthroid

0.05mg

Once daily in the morning

thyroid

Physicians and Providers: Please review this list and instruct the patient on any changes you make.

013006 (02-2012)

Provided by LifeWise Health Plan of Oregon and LifeWise Health Plan of Washington.

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Parent category: Medical