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Medicine List Examples / Ejemplos de Lista de Medicina

“Patients need to appreciate that they have a role in their health care.” –John Zarek, Director of Clinical Pharmacy for Swedish Medical Center, and a member of the Washington Patient Safety Coalition.

Tips:

  • If printing, print the two-page documents to a single page, front-to-back.
  • Save Word version files to your personal computer to be typed into and saved for later updates.

My Medicine List

My Medicine List –French version

My Medicine List –French version

“My Medicine List” vous aidera à controller tout ce que vous prennez pour être en bonne santé—vos pilules, vitamines et herbes. Avoir tous vos médicaments dans un même endroit aide aussi à votre médecin, pharmacien, hôpital ou des autres employés de santé à prendre meilleur soin de vous. PDF

 

AARP Medication List

AARP Medication List
The first page includes directions, personal information and general medical information. The second page includes a simple table to be filled in with list of medicines. PDF version, Word version

American Society of Health Systems Pharmacists – My Medicine List

American Society of Health Systems Pharmacists – My Medicine List
The first page includes directions with examples, personal information and general medical information. The second page includes a fairly detailed table organized by times of day that medicines are used. PDF version  

South Carolina Hospital Association Personal Medication Record Form

South Carolina Hospital Association Personal Medication Record Form
The first page includes personal information, general medical information and a simple table organized by date that medicines were started. The second page includes directions about how to fill out the table. PDF versionWord version

Expediente Personal de Medicamentos de La Asociación de Hospitales de Carolina del Sur

La primera página incluye información personal y información médica general junto con una simple tabla que organiza la fecha de cuando las medicinas fueron comenzadas. La segunda página incluye instrucciones en como llenar la tabla. PDF en Español, Word en Español

Arizona CERT – My Medicines List

Arizona CERT – My Medicines List
The first page includes instructions with examples, personal information, and general information. The second page includes questions to ask your doctor or pharmacist. PDF version

Arizona CERT – Mi Registro de Medicamentos

La primera página incluye instrucciones con ejemplos y información personal y información médica general. La segunda página incluye preguntas para hacerle a su médico o farmacéutico. PDF version

The Joint Commission – Speak Up™ My Medicine List

The Joint Commission – Speak Up™ My Medicine List
The first page includes a simple table organized by category of medicine. This table includes space for alcohol and recreational drugs. The second page includes directions with personal information and general medical information. This document can be trifolded to fit into a wallet. PDF version

Harney District Hospital – My Medication List

Harney District Hospital – My Medication List
The first page includes minimal directions with personal information and general medical information. The list of medicines starts on the first page and continues to the second page. The list is not organized into a table form. This PDF version allows data to be entered in and printed but not saved. PDF version

National Association of Chain Drug Stores Foundation and American Pharmacists Association – My Medication Record

National Association of Chain Drug Stores Foundation and American Pharmacists Association – My Medication Record
The first page includes a fairly detailed table with no specific organization. The second page includes personal information, general medical information and a recommended list of questions to ask health care providers. PDF version

Indiana Community Health Network – Pill Box

Indiana Community Health Network – Pill Box
This free application for your iPhone or iPod Touch allows you to manage and reference information about your medicines through an informative database. The database can link to your schedule and contacts. You can also keep separate lists for each of your family members or dependents. Link to download

Whatcom Health Information Network, LLC – HINET Medcard

Whatcom Health Information Network, LLC – HINET Medcard
The first page includes personal information and general medical information. The second page contains a simple table for listing medications, their purpose, and when and how many to take each day. PDF version