What is on the sheet
- My medicines: name, dose, how often, start date, what it is for, and who prescribed it
- Room for medicines you bought, vitamins, supplements and herbal products
- Allergies, and medicines that did not suit you
- Is it helping? Three dated checks for each new or changed medicine
- Worst pain from 0 to 10, bleeding, side effects and what changed
- Questions for your doctor
How to fill it in
- Fill in page 1 with everything you take now, including medicines you bought.
- Add a line when you start, stop or change a medicine.
- On page 2, write the medicine and the date you started or changed it.
- At each appointment, or when you notice a change, fill in one check.
- Take both pages to your appointments and to the pharmacy.
Why this helps
Keep a list of all the medicines you take, including prescription and over-the-counter medicines, vitamins, supplements and herbal products, and review it with your doctors and your pharmacist.
A doctor who does not know what you take may prescribe a medicine that interacts with one you already take. One up-to-date page prevents that.
If you notice side effects, tell your doctor, and do not stop a medicine unless they tell you to. The checks on page 2 give you dates and scores to show them, for example after you start a hormone treatment such as dienogest or Orilissa.
Questions
What should a medication log include?
The name of each medicine, the dose, how often you take it, when you started, what it is for and who prescribed it. Include over-the-counter medicines, vitamins, supplements and herbal products.
Can I stop a medicine if the log shows it is not helping?
Not on your own. Do not stop a medicine unless your doctor tells you to. Show them the log and ask what to do.
Is this medical advice?
No. The sheet is a record to share with your doctor. It does not diagnose any condition or replace care from a doctor.
Related guides
Prefer your phone?
Endolog, a pain and symptom diary app keeps the same records on your iPhone and makes a PDF report for your doctor.
Sources
- Taking multiple medicines safely, MedlinePlus, US National Library of Medicine
This printable is for keeping a record. It does not diagnose any condition or replace care from a doctor. Read how we write and check our content in our editorial policy.
