PATIENT RESOURCES
One current medication list.
Ready for your next conversation.
Keep a list of prescription medicines, nonprescription products, vitamins and supplements to bring to your pharmacist and care team. Use the blank worksheet below to prepare a paper copy.
BEYOND PRESCRIPTIONS
What belongs on your list?
For each medicine or product
- Name and strength, plus the dosage form if useful.
- The amount you take, how you take it and when.
- What you take it for, if known, and the prescriber if applicable.
- Nonprescription medicines, vitamins and supplements, including occasional use.
Alongside the medicine details
- Allergies or past medication reactions to discuss.
- An emergency contact and phone number.
- The date you last checked the list.
- Questions about labels, changes, interactions or instructions.
A USEFUL HABIT
Check the list when something changes
- 01
Update the information
Review it after your care team changes a medicine or its instructions. If records disagree, write down the question to resolve with your pharmacist or prescriber.
- 02
Keep the current copy handy
Bring it to pharmacy and medical visits. Include the date so you and your care team can tell which copy is current.
- 03
Agree who keeps it updated
If a caregiver helps, decide together who maintains the list and how to share changes. Ask your care team what information it needs.
PRINT & FILL IN BY HAND
My medication list
Download the one-page PDF or print this blank sheet and fill it in by hand. If a print preview does not open, use the PDF or your browser’s Print command. This page does not collect or store your medication information.
Victory Community Pharmacy · (818) 859-7040
101 N Victory Blvd, Unit C, Burbank, CA 91502
Name
Last updated
Emergency contact & phone
Allergies / reactions
| Medicine & strength | Amount & how taken | When taken | Reason / prescriber | Questions / notes |
|---|---|---|---|---|