Get Personal Medication Form

Completing the Personal Medication Form is essential for ensuring your healthcare team has a comprehensive understanding of your medication history. This guide provides you with clear, step-by-step instructions on how to accurately fill out this important document online.

Follow the steps to complete the Personal Medication Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred digital format.
2. Begin by entering your personal information, including your name, date of birth, and the date the form was last updated. This information helps ensure that your records are accurate and up to date.
3. In the allergies section, indicate if you have any allergies to medications, iodine, food, tape, or latex. List each substance you are allergic to along with the reaction you experienced.
4. For vaccines, check the appropriate box for each vaccine you have received, indicating if it was administered within the specified time frames or if your vaccination history is unknown.
5. In the medications section, you will need to thoroughly list all prescription and non-prescription medications, including herbals, eye drops, and nutritional supplements. Provide details for each medication, such as the name, dose, route of administration, directions for use, and the purpose of taking it.
6. If you have recently stopped any medications or have additional medications to include, list them on the back of the form, ensuring nothing is missed.
7. Complete the section regarding medications you have taken within the last week, including any medications you have withheld prior to a scheduled surgery.
8. Fill in your contact information, including your doctor's name and phone number, your pharmacy's name and phone number, and an emergency contact name and phone number.
9. After completing all sections, review the form for accuracy and completeness. You can then choose to save changes, download, print, or share the form as needed.

Take action now and fill out your Personal Medication Form online to ensure your healthcare information is up to date.