Keeping an up-to-date copy of the Universal Medication Form in your wallet is one way patients can take a more active role in their health. This form contains valuable information health care providers need when making decisions about your care.

Tips On Using This Form

  •  Keep a current copy of your Universal Medication Form with you at all times.
  • Always take your Universal Medication Form with you to the doctor's office so they can help you keep it up-to-date.
  • If you are admitted to the hospital, be sure to share your Universal Medication Form with the registrar. You'll receive a new Universal Medication Form before you go home.

Questions to Ask About Every Medicine You Take

  • What is the name of the medicine?
  • What is it for?
  • What time should I take it?
  • How much of it should I take each time?
  • How should I take it?
  • Should I take this medicine with food?
  • How long should I take this medicine?
  • What should I do if I miss a dose?
  • Are there any side effects? What should I do if I have any reactions to this medicine?
  • Is it safe to take this medicine with the other medicines I'm currently taking, including herbs, supplements or over-the-counter drugs?
  • Which food, drinks or activities should I avoid while taking this medicine?

Download the Universal Medication Form in Spanish (DOC).


You can also download the Universal Medication Form as a PDF in English or Spanish.