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

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

Form to List and Organize Medication Information

Prescription medicines
Name of Medicine & Dosage Reason Taken Color, Size, Shape Times Taken Notes
     
     
     
     
     
     
     
     
     

Over-the-Counter Medicines
(Check here if you use any of these)
  Laxatives   Cough medicine    
  Diet pills   Allergy relief medicine    Take a list of your medications with you
  Vitamins   Antacids   any time you visit your Health Care
  Cold medicine   Sleeping pills   Provider.
  Aspirin or   Others (names)    
  other pain,
headache, or
fever medicine		  

   

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"http://www.udel.edu/geriteach/project/watson-app-k.html"
Last updated August 4, 1998.
Copyright Norine Watson, 1998.