The directions for medication often changes from what is written on the bottle. When the doctor gives new orders at doctor visits or over the phone, this form is especially helpful in keeping that medication information up-to-date. Enter the date changes are made in the upper right hand corner. Be sure to take this form to all doctor and hospital visits. You usually do not need to take your medication bottles with you if you take this form. The name of the medication, the dosage, directions, and the reason it is being taken are all documented on this form. Circling the Allergy/Reactions with a red felt pen will help to draw attention to this important piece of information. There is a place for primary doctor contact information and additional information may be entered under Notes at the bottom.
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This picture is just to give you a general idea of what the forms will look like. Turning the form into a picture has greatly reduced the quality, so there are distortions that do not appear in the actual form.