Free Medication List For Seniors Template
Medication List For Seniors
I. Patient Information
|
Name |
Age |
Gender |
Emergency Contact |
|---|---|---|---|
|
Roland Grant |
75 |
Male |
Carol Grant (spouse) - 222 555 7777 |
II. Healthcare Provider Information
|
Name |
Specialty |
Email Address |
|---|---|---|
|
[Your Name] |
Primary Care |
[Your Email] |
|
Dr. Wilson Cook |
Cardiologist |
wilson@email.com |
III. Medication Schedule
|
Medication |
Dosage |
Frequency |
Purpose |
Special Instructions |
|---|---|---|---|---|
|
Lisinopril |
10 mg |
Once daily |
Hypertension |
Take with water |
|
Metformin |
500 mg |
Twice daily |
Diabetes |
Take with meals |
|
Atorvastatin |
20 mg |
Once daily |
High Cholesterol |
Take at bedtime |
|
Warfarin |
5 mg |
Once daily |
Blood Thinner |
Monitor INR regularly |
|
Levothyroxine |
75 mcg |
Once daily |
Hypothyroidism |
Take on an empty stomach |
IV. Over-the-Counter Medications and Supplements
|
Medication/Supplement |
Dosage |
Frequency |
Purpose |
Special Instructions |
|---|---|---|---|---|
|
Aspirin |
81 mg |
Once daily |
Blood Thinner |
Take with food |
|
Vitamin D |
1000 IU |
Once daily |
Bone Health |
Take with water |
|
Calcium |
500 mg |
Twice daily |
Bone Health |
Take with meals |
V. Allergies and Adverse Reactions
|
Medication/Substance |
Reaction Type |
Notes |
|---|---|---|
|
Penicillin |
Rash, Swelling |
Avoid all penicillin derivatives |
|
Ibuprofen |
Stomach Upset |
Prefer acetaminophen for pain relief |
VI. Important Reminders
-
Consistency in Medication Schedule: Ensure medications are taken at the same time each day to maintain effectiveness and minimize the risk of missed doses.
-
Regular Medication Review: Schedule periodic reviews with the healthcare provider to reassess the necessity, dosage, and interactions of medications, especially if new conditions arise or existing ones change.
-
Monitoring for Side Effects: Keep an eye out for any adverse reactions or side effects from medications and promptly report them to the healthcare provider for appropriate adjustments or interventions.
