Free Pocket Medication List Template
Pocket Medication List
|
Patient Name: |
[YOUR NAME] |
|
Date: |
[CURRENT DATE] |
Overview
This list contains all necessary information regarding personal medication details, dosages, frequency, and their purpose. Additionally, it includes emergency contact information. This pocket list should be kept in an accessible location for emergency purposes.
Medication Details
|
Medication Details |
Notes |
|---|---|
|
Medication Name |
Ibuprofen |
|
Dosage |
200mg |
|
Frequency |
Every 6 hours |
|
Purpose |
Pain relief |
|
Medication Name |
Dosage |
Frequency |
Purpose |
|---|---|---|---|
|
Medicine 1 |
2 mg |
Once daily |
Heart disease |
|
Medicine 2 |
1 pill |
Twice daily |
Diabetes |
Allergies Details:
|
Allergies |
Medicines |
|---|---|
|
Known Allergies |
Penicillin |
|
Allergic Reactions |
Rash |
Medical Conditions Details:
|
Medical Conditions |
Notes |
|---|---|
|
Existing Medical Conditions |
Hypertension |
|
Special Instructions |
Take with food |
Emergency Contact Information
|
Primary Physician |
Emergency Contact |
Emergency Phone Number |
|---|---|---|
|
Dr. Smith |
John Doe |
123-456-7890 |
Notes:
-
Please ensure this Pocket Medication List is kept in an easily accessible location, such as a wallet or purse, in case of emergencies.
-
Always keep your physician and emergency contact informed about any changes in your medication or health condition.
-
It's also a good idea to share this list with a trusted family member or friend.
-
If medication dosage or frequency changes, update this list immediately to avoid any confusion.
