Fillable MY MEDICATION WALLET CARD

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MY MEDICATION WALLET CARD

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File type: PDF

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MY MEDICATION WALLET CARD
Name:
Phone:
Emergency Contact:
Number:
My Doctor:
Number:
My Pharmacy:
Number:
Allergies:
Medication
This medication is
for…
Number of
pills I take
everyday
Time of
day
(AM, PM)
Day to visit
pharmacy to
get my refill
3. What if I miss a dose?
QUESTIONS to ask your pharmacist/doctor:
1. What is my medicine called and what does it do?
2. How and when should I take it?
4. Are there any side effects?
5. Is it safe to take with other medicine or vitamins?
6. Can I stop taking it if I feel better?
Remember to always take your medication as directed. If you have any
concerns with your medication, consult with your pharmacist/doctor.
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MY MEDICATION WALLET CARD

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Completed 19 April 2022

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