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Talking with Your Doctor

Tracking Your Medications: Worksheet

You may be taking many different medicines as well as numerous vitamins and over-the-counter drugs. It can be confusing to keep track of everything! This form can help. Because your medication regimen may change over time, make a copy of the blank form (PDF, 57K) so you will always have a clean copy to use. Try to bring a completed and updated copy of this form to every doctor appointment.

Name of Drug What It's For Date Started Doctor Color/Shape Dose and Instructions
           
           
           
           
           
           
           
           
           
           
           
           

This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA scientists and other experts review this content to ensure that it is accurate, authoritative, and up to date.