Worksheet 5 Medications
You may be taking many different medicines as well as numerous vitamins and over-the-counter drugs. It can be confusing to keep track of everything! This form can help. Because your medication regimen may change over time, tear out this form and make a copy of the blank form so you will always have a clean copy to use. Or you can download additional copies from NIA’ s website at www. nia. nih. gov / health / twyd-worksheets. Try to bring a completed and updated copy of this form to every doctor appointment.
Name of Medication |
What It’ s For |
Date Started |
Doctor |
Color / Shape |
Dose |
When and How Often |
|
| | | | | |
Talking With Your Doctor 47