What is a Universal Medication Form?

The Universal Medication Form is a tool developed for patients to keep track of all of their prescription medications, over–the–counter medications and herbal supplements.

This form helps you. Hazardous drug interactions can be prevented by knowing what medicines you are taking. If you need help completing the form, ask your doctor, nurse, pharmacist or family member for assistance.

Things to remember ...

• Always keep your Universal Medication Form with you. You may want to fold it and keep it in your wallet along with your driver’s license.
• Complete a Universal Medication Form not only for yourself, but for all of your dependents as well.
• Take your Universal Medication Form to all doctor appointments, hospital inpatient stays and outpatient procedures.
• Remember to write down any changes made to your medicines on the Universal Medication Form. If you need help, ask your doctor, nurse, pharmacist or family member for assistance.
• Remember, it’s very important to include non–prescription medicines on your Universal Medication Form. Some herbal supplements can have dangerous side affects with prescription medicines.

... At the doctor’s office

• Always take your updated Universal Medication Form with you.
• Tell your doctor about any allergies or reactions that you have had to medicine(s) in the past.

... At the hospital

• When you are admitted to the hospital, take your updated Universal Medication Form with you, or bring all of your medicines in the original containers.
• Remember to include vitamins, supplements or other over–the–counter medications on your Universal Medication Form.
• Tell your doctor or nurse about any allergies or reactions that you have had to medicine(s) in the past. Don’t forget to write these on your Universal Medication Form.
• If you feel that a medicine is making you sick or causing pain, tell the doctor or nurse right away.
• When you’re ready to go home from the hospital, ask your doctor or nurse toclearly tell you what medicines you should be taking and how to take them.You will be given an updated Universal Medication Form before you leave.

... At the pharmacy

• Take new medicine prescriptions and refills to the same pharmacy. The pharmacist can make sure that all of your medicines work together and will not make you sick.
• If you use more than one pharmacy, make sure each one has your updated Universal Medication Form.
• Ask the pharmacist the name of the medicine and how you should take it. Make sure this matches with what your doctor or nurse told you.
• Make sure that any refill of the medicine is the same color, size and shape. If there is a difference, be sure to ask why.
• If you have any questions about your medicine(s), be sure to ask.

You can also call (816) 271-4098 to receive your FREE Universal Medication Form. For safety’s sake, use the Universal Medication Form to keep track of your medicines.