Click here to download the Universal Medication Form
The Universal Medication Form is a chart to help you and your family members keep a current record of information that physicians need to know. This record includes immunizations, allergies, prescribed medications, and any vitamins, herbal supplements or over-the-counter medicines.
Fill in all the blanks on the form that apply to you. List all medications and the physician(s) who prescribed them. Include any vitamins, herbal supplements, or over-the-counter medicines. Write neatly so that others can read your form.
Bring this form with you whenever you visit your physician, go for tests, or when you are admitted to the hospital. Make sure that the form is up-to-date.
Keep this form in your wallet or purse so that it is always with you. This will help healthcare providers locate the form in case of an emergency.
Yes. Whenever you change medications, scratch through the old medication and write in the new information.
Fill out a new form. There are often many medication changes following a hospital stay. Before you leave the hospital, someone will tell you which medicines to take and which medicines to stop taking. When you return to your physician, take your new form with you.