Universal Medication Form

The Universal Medication Form helps you and your family members keep a current record of information that physicians need to know. This record includes immunizations, allergies, prescribed medications, and any vitamins, herbal supplements or over-the-counter medicines that you take.

How to Use the Universal Medication Form

First, download and print the form.

Next, fill in all the parts of the form that apply to you. List all medications that you are currently taking and the physician(s) who prescribed them. Include any vitamins, herbal supplements, or over-the-counter medicines.

Keep the form with you in your wallet or purse so that healthcare providers will have it in case of emergency.

Whenever you go to a doctor, go to health tests or are admitted to the hospital, bring the form with you and update it. Whenever you change medications, scratch through the old medication and write in the new information.

If you have a number of new or changed information, be sure to fill out a new form.