Universal Medication Form

Use our universal medication form to keep a record of all the medications and supplements you’re taking, what immunizations you’ve had, and if you have any allergies.

Having a printed record of this information can ensure your healthcare providers have the latest information about you. Keep a folded copy of the completed form in your wallet and you’ll have it for doctor’s appointments or when you go to the hospital. It’s a convenient way to make this important information easily accessible to you, your loved ones and your healthcare providers.

What to Include on Your Medication Form

Simply download the form, print it out, and fill in all the information that applies to you, including:

  • Prescription medications
  • Over-the-counter medications
  • Vitamins
  • Herbal supplements
  • Allergies
  • Immunizations, including flu shots

The medication form provides areas for specifics, including dosage, dates and other details. As things change, ask your doctor, nurse and pharmacist to help you keep your form up to date.

Why the Medication Form Is Important

When you use the universal medication form, it benefits both you and your healthcare team. Keeping the updated form with you at all times: 

  • Assures accuracy. It’s easy to forget to mention a medication or a recent change. Having a printed copy with you means your doctor always has accurate, up-to-date information.
  • Keeps you safe. The form can help prevent prescription duplication or adverse interactions from medications. It also informs your healthcare team about allergies or reactions to certain medications.
  • Saves time. When asked about medications your taking or any allergies, you can provide healthcare providers with a copy of the list, leaving more time to discuss your health concerns.