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Personal Medication Tracking Guide

This document provides a template for tracking personal medication information. It includes sections for personal details, emergency contacts, physicians, pharmacies, allergies, medical conditions, and a table to list current and past medications with details on dosage, use, dates, and notes. The instructions explain that the document should be saved, edited regularly to track medications, and shared with doctors and pharmacists.

Uploaded by

Christian Christopher Lopez
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
143 views2 pages

Personal Medication Tracking Guide

This document provides a template for tracking personal medication information. It includes sections for personal details, emergency contacts, physicians, pharmacies, allergies, medical conditions, and a table to list current and past medications with details on dosage, use, dates, and notes. The instructions explain that the document should be saved, edited regularly to track medications, and shared with doctors and pharmacists.

Uploaded by

Christian Christopher Lopez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

My Personal Medication Record

My Personal Information How to Use This Guide


Name • Save this document to your PC.
Date of Birth • Edit the copy on your PC to keep track of your medications
(including prescription drugs, over-the-counter drugs, herbal
Phone Number supplements, and vitamins.)
Emergency Contact • Share the information with your doctors and pharmacists at all
Name visits.
Relationship • Keep a printed copy always with you.
Phone Number
You should review this record when
Primary Care Physician
• Starting or stopping a new medicine.
Name • Changing a dose.
Phone Number • Visiting your doctor
Pharmacy/Drugstore
Pharmacist Last Updated:
Phone Number

Other Physicians My Allergies


Name of Physician
Specialty
Phone Number

Name of Physician My Medical Conditions


Specialty
Phone Number

Name of Physician
Specialty
Phone Number

In Cooperation with the SOS Rx Coalition


Start/Stop Notes,
What I’m Form How Much Use Directions,
Dosage Dates
(pill, injection, (regularly or
taking and When (1/5/05 - 3/5/05) Reasons for
liquid, patch, etc.) occasionally)
(1/5/05 - ongoing) Use
* Be sure to include ALL prescription drugs over-the-counter drugs, vitamins, and herbal supplements.
1

10

11

12

In Cooperation with the SOS Rx Coalition

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