Lakeland Regional Health


Patients & Visitors
Patients & Visitors

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My Medication List

Download the form

Instructions on Using and Completing the Form

  1. Always keep this form with you.
  2. Take this form to all doctor visits and all medical testing (lab, x-ray, MRI, CT, etc.). Take this form to all pre-assessment visits for admission or surgery and all hospital visits (ER, in-patient admission, out-patient visits).
  3. Update this form as changes are made to your medications. When a medication is stopped, draw a line through it and record the date it was stopped. If help is needed, ask a physician, nurse, or pharmacist to help you fill out this form.
  4. Tell your family, friends and neighbors about the benefits of using this form.
  5. When you are discharged from the hospital, you will get an updated list of your medications. This will be reviewed with you and you will be given a copy. When you return to your doctor, take your updated list with you. Always keep this form with you. This will keep everyone up-to-date on your medications.

By using a current medication list and keeping it updated, you can:

  • Reduce confusion and save time. It helps you remember your medications.
  • Improve communications. Provide doctors, health care providers and institutions with a current list of all of your medications. Lets the patient and/or family member know exactly what medications are to be taken and when.
  • Improve MEDICATION SAFETY. Medication interactions and duplications can be detected and corrected.

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