Write down the name of each medicine you take, the reason you take it, and when you start and stop in the spaces below. Add new medicines when you get them. You can show the list to your doctor and pharmacist. You may want to make copies of the blank form so you can use it again.
| Name of Medicine | Reason Taken | Date Started | Date Stopped |
|---|---|---|---|
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Pocket Guide to Staying Healthy at 50+