Medication List Template Page 3
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4Medication List
List all the medications you take. Include patches, inhalers, eye/ear/nose drops, creams,
and ointments. Also include over-the-counter medication, vitamins, minerals, herbal products,
This list was updated: ______/______/_____
or recreational drugs (for example, alcohol or marijuana)
yyyy
mm
dd
Keep your list up to date by crossing out the old medications and adding the new ones.
Name of medication
Dose
How much
How often and when
Why I take it
Additional Information
Morning
Afternoon
Evening
Bedtime As Needed
Adapted from ‘It’s Safe to Ask Medication Card’ Manitoba Institute for Patient Safety.
To find out more, visit
If it’s on the list, it won’t be missed
1-866-408-5465 (LINK)
or call Health Link Alberta:
toll-free.
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Parent category: Medical