My UAB Medicine Toolkit | Page 44

MEDICATIONS MEDICATION NAME TESTS OR PROCEDURES AND RESULTS Use this space to write down any test or procedure you may have and the results. DESCRIPTION When did I take it? DOCTOR DAILY SCHEDULE Why did I take it? Test / Procedures How did I take it? Results / Comments WHY SPECIAL INSTRUCTIONS NOTES MEDICATION NAME DESCRIPTION When did I take it? DAILY SCHEDULE Why did I take it? How did I take it? _________________________________________________________________________________________________ _________________________________________________________________________________________________ DOCTOR _________________________________________________________________________________________________ WHY _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ SPECIAL INSTRUCTIONS _________________________________________________________________________________________________ _________________________________________________________________________________________________ MEDICATION NAME DESCRIPTION When did I take it? DAILY SCHEDULE Why did I take it? How did I take it? _________________________________________________________________________________________________ _________________________________________________________________________________________________ DOCTOR _________________________________________________________________________________________________ WHY _________________________________________________________________________________________________ _________________________________________________________________________________________________ SPECIAL INSTRUCTIONS _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 40 uabmedicine.org 41