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Use this page to keep track of the medications that you are taking.

Your nurse will review this information at your visits.

Medication Name

Strength

How often do you take this medication?

Date Initially
Prescribed & Date
Discontinued

Prescribing Doctor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

"Recording Your Care" - Table of Contents

>>  Contacting your Medical Team

>>  Medications and Chemotherapy List

>>  Record of Blood Counts

>>  Treatment Calendar

Last Modified: Thursday, April 21, 2005

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the Health Sciences Center at the University of Utah.

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