Personal Medication List Template - Cigna Page 3
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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:
Other Information:
All Cigna products and services are provided exclusively by or through operating subsidiaries of
Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna
Intellectual Property, Inc. Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO
and PPO plans in select states, and with select State Medicaid programs. Enrollment in Cigna-
HealthSpring depends on contract renewal.
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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