HEALTH PROMOTION PROGRAMS FOR OLDER ADULTS:
Involving Baccalaureate and Graduate Nursing Students

APPENDIX D
Table of Contents   -   Chapter 1   -   Chapter 2   -   Chapter 3   -   Chapter 4   -   Appendices

Medication Use Assessment
Program pre-assessment

  1. What medications are you currently taking?

    Prescription (include why)

    1.  
    2.  
    3.  
    4.  
    5.  
    Non-Prescription (over-the-counter)
    1.  
    2.  
    3.  

  2. How would you rate this medication’s effectiveness:
              Very good       Not Sure       No apparent effect
    1.  
    2.  
    3.  
    4.  
    5.  
    6.  
    7.  
    8.  

  3. What potential side effects are associated with these medications?
    1.  
    2.  
    3.  
    4.  
    5.  
    6.  
    7.  
    8.  

  4. Did you feel that you received adequate information with new prescriptions?

    1. From your pharmacist

    2. From the person who prescribed the medication

  5. Do you take your medication as prescribed?

    1. Who or what could help you in taking your medications as prescribed?

Please try to attend the medication use program offered here at the Newark Senior Center on November 12th at 10:00A.M.!

[UD logo] GT Comments, suggestions, or requests to ud-geriteach@udel.edu.

"http://www.udel.edu/geriteach/project/watson-app-d.html"
Last updated July 12, 1998.
Copyright Norine Watson, 1998.