Personal Medication List Template - Cigna Page 2
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2
3Medication:
How I use it:
Why I use it:
Prescriber:
Notes:
Date I started using it:
Date I stopped using it:
Why I stopped using it:
Medication:
How I use it:
Why I use it:
Prescriber:
Notes:
Date I started using it:
Date I stopped using it:
Why I stopped using it:
Medication:
How I use it:
Why I use it:
Prescriber:
Notes:
Date I started using it:
Date I stopped using it:
Why I stopped using it:
Medication:
How I use it:
Why I use it:
Prescriber:
Notes:
Date I started using it:
Date I stopped using it:
Why I stopped using it:
Medication:
How I use it:
Why I use it:
Prescriber:
Notes:
Date I started using it:
Date I stopped using it:
Why I stopped using it:
If you have any questions about your medication list, call your physician,
pharmacist, or medication therapy management provider at 1-800-625-9432.
INT_15_24322
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