Dr. Irene's Health and Nutrition Tidbits
Instructions for Section 5A: Prescription Medication Log
Sorry, the Personal Health Record Binder
The purpose of this form is to have a record of medicine your
doctor has ordered for you, why it was ordered, and whether it helped
you. Doctors that you visit
need to know all the medication you currently take or have taken in the
In the first and second column you record the date started and
stopped. If there is no
“stopped” date, it is assumed that you are still taking the
medication. Make sure you
put a date in that column when you stop taking a medication.
In the third column, “Medication & Dose”, copy exactly
what the label says. If
your doctor has told you something different than what you see on the
label, call the doctor to clarify.
Write in this column exactly how you are supposed to take the
medication. (Record all
telephone conversations in your telephone log).
In the fourth column, indicate the doctor’s name under “who
In the fifth column “Reason”, put the medical condition or
symptom for which the drug was prescribed.
The sixth column is very important.
Always document any problems with the medication and call your
doctor if side effects are serious or prevent you from taking the
medication. Also record if
it helped. In the last
column record the page of the doctor’s visit during which this
medication was prescribed.
If at any time your dose or frequency of the medication changes,
put a “date stopped” date on the line of the old dose and start a
new line. If this was due
to a telephone conversation rather than a visit, record the conversation
on your telephone log and under the last column, “details”, write
you need more space for any column, use more than one line. When you understand these instructions, place them
in Section 10A for future reference.