Patients & Visitors

Universal Medication Form

People today often take several medications at a time - some they can't remember by name, some they forget to tell their doctors about, some they don't take correctly. In an effort to assist our patients, Doctors Hospital of Augusta offers this resource to help patients pay more attention to what they are taking. We have created the patient medication record for patients to dowload and complete, in order to help patients keep track of prescription, non-prescription, herbal and supplements they are currently taking.

Download Universal Medication Form

  1. ALWAYS KEEP THIS FORM WITH YOU.  You may want to fold it and keep it in your wallet or in an easily accessible location in case of an emergency.
  2. Write down all of the medicines you are taking and list all of your allergies.
  3. Take this form to ALL doctors visits, when you go for tests and ALL hospital visits.
  4. WRITE DOWN ALL CHANGES MADE TO YOUR MEDICINES on this form. If you stop taking a certain medicine, draw a line through it and write down the date it was stopped. If help is needed, ask your doctor, nurse, pharmacist or family member to help you keep it up-to-date.
  5. When you are discharged from the hospital, someone will talk with you about WHICH MEDICINES TO TAKE AND WHICH MEDICINES TO STOP TAKING. Since many changes are often made after a hospital stay, a new form should be filled out. When you return to your doctor, take your new form with you. This will keep everyone up-to-date on your medicines.

How Does This Form Help You?

  1. This form helps you and your family members remember all of the medicines you are taking.
  2. Provides your doctor(s) and others with a current list of ALL of your medicines. Doctors need to know the herbals, vitamins, and over-the-counter medicines you take!
  3. Helps you—concerns may be found and prevented by knowing what medicines you are taking.

Download Universal Medication Form