medication form

Carrying a list of medications you take may save your life. At Bon Secours, we recommend using this card to pencil in and list all of the medications you are taking (even non-prescription and herbal ones) so that you can share this information with a doctor when needed. Each time your doctor changes your prescription or writes a new one for you, take out this card so you or your doctor can add the new medication(s) to the card or change the current information so that it is always accurate.

Download the List for Life medication form

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