INSTRUCTIONS FOR COMPLETING FORM:
This form can be modified and adjusted according to the individual patient’s needs. It is important to be as concise as possible and keep daily records. These records will assist you when visiting the doctor and for symptom and pain management.
If the patient should ever go to the hospital you will need an accurate list of ALL medications the patient is taking. This daily form will come in handy. This should be used for all forms of medication: patches, pills/capsules,inhalers and ordinary “over-the-counter” medications, such as Tylenol.
For all prescriptions:
Consult the pharmacist about the medications the patient takes; the pharmacist needs to know ALL medications.
Read the description – especially what the medication is used for and the contraindications with other medication (this should be included on the form, especially when there are a lot of medications, and for sharing this information with other caregivers for the patient). Additionally, it helps to research medication on the internet to know more about the medication.
Be aware of any possible problems or symptoms that may develop and notify the doctor/pharmacist immediately.
Note special instructions for taking the medication:
-full or empty stomach
-with or without dairy products
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- certain foods cannot be eaten that may affect the potency of the medication, e.g.grapefruit.
IMPORTANT:
The more you know about the medication the patient is taking – the better the patient will be. Believe it or not doctors and nurses can make mistakes…..and have!! Many times even they are unaware of contraindications – so be on your toes. It is best to stay in the hospital overnight, whenever possible, to ensure the best possible care.
<a href=”http://www.supportivecareexchange.com/daily-medication-form/”>Click here to download the form</a>