Scribd
Upload
6 views2 pages

Sample Medication Log Template

The document is a sample medication log for an individual named David Smith, detailing his prescription medications, dosages, start dates, purposes, side effects, and instructions. It also includes sections for allergies, current medical conditions, and things to avoid. Key medications listed include Donepezil for Alzheimer's and Benazapril for blood pressure.

Uploaded by

s-o-n-n-y
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
6 views2 pages

Sample Medication Log Template

The document is a sample medication log for an individual named David Smith, detailing his prescription medications, dosages, start dates, purposes, side effects, and instructions. It also includes sections for allergies, current medical conditions, and things to avoid. Key medications listed include Donepezil for Alzheimer's and Benazapril for blood pressure.

Uploaded by

s-o-n-n-y
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Sample Medication Log

Name: ______________________________________________________________________________
David Smith Date: ________________________
5/01

Prescription Medications / Over-the-Counter Products / Vitamins / Herbal Supplements


Name of Prescribing Doctor Name of Medication Dosage Date Started What is it for? Side Effects Instructions
Dr. Petersen Donepezil 10 mg 5/01 Alzheimer’s Nausea Once per day
(Aricept) disease with food
Dr. Jones Benazapril 20 mg 3/00 Blood Dizziness Once per day
pressure in the a.m.
Dr. Jones HCTZ 25 mg 3/00 Blood Urinary Once per day
pressure Incontinence in the p.m.
Dr. Petersen Naproxen 375 mg 11/01 Pain Twice per day
with food
Dr. Petersen Tylenol 500 mg 11/01 Pain Take as needed
with Codeine

Vitamin E 2,000 IU 3/00 Memory


Multivitamin 1/95 General Take in
Health the morning

Allergies: Current Medical Conditions/Illnesses: Things to Avoid (food, drink, activities):

Penicillin Alzheimer’s disease Alcohol

High blood pressure Benadryl

Caffeine
Medication Log

Name: ______________________________________________________________________________ Date: ________________________

Prescription Medications / Over-the-Counter Products / Vitamins / Herbal Supplements


Name of Prescribing Doctor Name of Medication Dosage Date Started What is it for? Side Effects Instructions

Allergies: Current Medical Conditions/Illnesses: Things to Avoid (food, drink, activities):

You might also like