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Personal medication form



One of the most important steps you can take to help ensure your health and safety when in the hospital is to share a comprehensive list of the current medications you’re taking with your physicians and hospital staff. Misinformation can lead to serious medication errors. To help you keep track of the medication names, dosages and how often they’re taken, use the personal medication form below. After completing the form, make sure you carry it with you at all times, and remember to keep it up-to-date with any new medications (including over-the-counter drugs and herbals).

Personal medication form