Universal Medication Information Forms

The Universal Medication Information Form enables you to keep a handy, up-to-date record of all the medicines you are taking. It is important that your healthcare providers have a complete list so they can review for any possible concerns with mixing certain medications.

• Use the form to list all prescriptions, over-the-counter medications, vitamins and herbals you are taking.
  • Anyone who takes several medications each day needs to use this form.
• Take the form with you to all doctor visits and diagnostic tests. Have the doctor update the form at each visit.
  • This form will improve medication safety by improving communication, reducing confusion and saving time.
• If you have a medical emergency, take the form with you to the Emergency Room.
  • Fold the form and keep it in your wallet, pocket or purse.