Detailed Medication List

Each time a medication is prescribed, add it to the chart. Fill in the medication name, reasons for the prescribed medication, dosage, and times to take the medication.

𝗛𝗢𝗪 𝗧𝗢 𝗨𝗦𝗘 “𝗠𝗬 𝗠𝗘𝗗𝗜𝗖𝗔𝗧𝗜𝗢𝗡 𝗟𝗜𝗦𝗧”:

Use a pencil(pen) or type to record on this form your personal information, all the medicines you take, and your allergies. Use your medication labels, your doctor, your family members, your pharmacists, and your medication profile from your pharmacist to fill out this form completely. Always update this list with any additions or changes in your medicine and keep it with you at all times. Take this form with you to all health care visits. If you go to the hospital or your doctor for a planned procedure, take your medicines with you in their original bottles.

𝗛𝗢𝗪 “𝗠𝗬 𝗠𝗘𝗗𝗜𝗖𝗔𝗧𝗜𝗢𝗡 𝗟𝗜𝗦𝗧” 𝗛𝗘𝗟𝗣𝗦 𝗬𝗢𝗨:

This form will help you remember all the medicines you take. It also provides your doctor and other health care providers with a current list of your medicines and why you take them. Knowing what medications, you are taking helps the hospital and your doctors ensure you get the right medications, at the right dose, without interactions with your other medicines.

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𝗣𝗥𝗢𝗗𝗨𝗖𝗧 𝗜𝗡𝗙𝗢𝗥𝗠𝗔𝗧𝗜𝗢𝗡

• Your purchase includes an A4 size.
• Text and colors that are part of the design CAN NOT be altered.
• Room for hole punches on either side.
• Perfect for home and office use.
• Print as many pages as you need.
• Simply print from your home printer or send it to a local printing shop.

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𝗘𝗗𝗜𝗧𝗔𝗕𝗟𝗘 𝗧𝗘𝗠𝗣𝗟𝗔𝗧𝗘𝗦

▪ When you open the file there will be light blue boxes where you can type in your information (this will NOT remain light blue when printed)
▪ You can still print and hand-write on the sheets (the blue boxes won’t appear on your printed copy)
▪ The fillable font is Arial in black. This cannot be changed.
▪ Checkboxes are not editable
▪ The actual layout of the printable including pattern, pattern color, font style, existing text, etc., is not editable and cannot be changed.

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𝗗𝗢𝗪𝗡𝗟𝗢𝗔𝗗 𝗣𝗥𝗢𝗖𝗘𝗦𝗦
1. Add the item to your cart
2. Select a payment method
3. Once the payment is complete, the download will be available in your purchase area. (Go to You > Purchases and Reviews > Click the button “Download Files”)
4. When downloaded, you can print as many copies of the design as you’d like
5. Files are to be opened in Adobe Acrobat Reader– you will need to use a computer or laptop (not an iPhone or iPad). If your laptop/computer does not have a PDF viewer, please download it here [www.get.adobe.com/reader]
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𝗣𝗥𝗜𝗡𝗧𝗜𝗡𝗚
The planner page is black & white to reduce printing costs
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𝗜𝗠𝗣𝗢𝗥𝗧𝗔𝗡𝗧 𝗡𝗢𝗧𝗘𝗦:
1. For reading PDF files you might need Adobe Acrobat Reader, here’s a link for a free download: https://get.adobe.com/reader/
2. You can print as many copies as you want, but please note – the item is for your personal use ONLY.
It is NOT allowed to share/distribute/resell or copy planner pages in order to sell them as your own work.
3. The item is NOT editable and will come as shown in the listing pictures.
4. Due to this being a digital product, no refunds will be given. If you have any questions, please ask before purchasing.
5. This is not a legal document.

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𝗤𝗨𝗘𝗦𝗧𝗜𝗢𝗡𝗦?

Please contact me if you have any problems with the files. I do my best to reply to all messages within 24 hours on weekdays and 48 hours on weekends.

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𝗧𝗘𝗥𝗠𝗦 𝗢𝗙 𝗨𝗦𝗘

©ModernFiftyTV All Design are Copyrights of Modern Fifty TV. They may not be resold, copied beyond each individual purchase, or distributed without consent.

Although this product is a digital download, only one person per purchase is authorized to use it. Please purchase additional copies if you’d like to share them with others. If interested in bulk purchasing, please contact me to discuss a reduced price. Thank you for respecting my copyright policy.