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Caregiver tools / Medication list

Free printable worksheet

Medication list maker.

Keep a current list of medicines and supplements to bring to a visit or review with a pharmacist. Fill in what you know; blank fields are fine.

Your information stays in this browser while you use this tool.

Nothing you type is sent to Nurtaire or saved by this tool. The tool does not retain entries; your browser may keep form data until you clear it or close the page. Printing or saving a PDF creates a separate copy; choose a safe destination and share it only with someone you trust.

About the person
Medicines and supplements

Include prescription and over-the-counter medicines, vitamins and supplements, including those taken as needed. Record what is actually taken and ask the care team about differences from the label.

Care contacts and notes

Review the list with a clinician or pharmacist. Do not change or stop a medicine based on this worksheet.

Source: FDA: Create and keep a medication list.