Being safe about your medications could save your life. One important safety tip is to know exactly what medications – prescriptions, over the counter medications and herbal supplements – you take, how much you take and when you take them…and to be able to give this information to your caregivers.

What is the Universal Medication Form?

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

I have printed this form, now what do I do?

Fill in all the blanks on the form that apply to you. List all the medications and the physician(s) who prescribed them. Include any vitamins, herbal supplements, or over-the-counter medicines. Write neatly so that others can read your form.

Where should I keep this form?

Keep this form in your wallet or purse so that it is always with you. This will help health care provider locate the form in case of an emergency.

I have been to the doctors and my medications have changed, should I scratch them out on the form?

Yes. Whenever you change medications, indicate it on the form.

I have been discharged from the hospital and there are a number of changes. What should I do?

Fill out a new form. There are often many changes following a hospital stay. Before you leave the hospital, someone will tell you which medicines to take and which medicines to stop taking. When you return to your physician, take your new form with you.

Learn more about Medication Safety.