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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.

Click here to download a printable version of the Universal Medication Information Form.