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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