|
Always carry a list of the medications (prescription and over-the-counter) and herbal supplements that you routinely take, including the dosage and frequency. Make sure that you share this information with your doctors and nurses. If you brought any of these medications to the hospital with you, please send them home with a loved one or visitor. Don't recognize a medication? Ask the caregiver to check it before you accept it.
TRACK YOUR MEDICATIONS HERE AT WWW.EDWARD.ORG/MEDCARD:
Use this page to track your medications. Click the printer icon above on the right to print out this medication tracking form and bring this to the hospital on your next visit. We've provided links to additional medication tracking resources below:
Wallet card: PDF version or Word version (view in Print Layout);
Online resources include http://www.ihealthrecord.org/ and http://www.healthvault.com/.
|
Name
|
| Date of Birth |
Allergies (Drug, food, etc.)
|
Medical Conditions
|
Emergency Contact (name and phone)
|
Current Medications (RX & Over-the-Counter)
| Drug (Brand/Generic Names) |
Strength |
Directions for Use |
Ordering Physician |
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
Herbal & Dietary Supplements
SUPPLEMENT
(Herbal,Vitamin, Mineral, etc.) |
STRENGTH |
FREQUENCY OF USE
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| |
|
|
|
