Medication Record and Repeat List

Who this is for

The list you hand over when somebody asks what you take. The first table holds every medicine copied straight from its label, whether you are on it now or it has been stopped or changed and by whom; the second is the ordering side, so a repeat goes in before the box runs out.

Anyone taking more than one or two medicines, people whose list changes after every clinic, relatives and carers ordering on somebody else's behalf, and anybody who has been asked to bring their medicines to an appointment and taken a carrier bag.

What this helps you track

• What you are taking now, in the words printed on the label
• Who prescribed each one and when you started it
• Medicines stopped or changed, with the date and who decided, kept on the same list
• When each repeat was last ordered and collected
• The date you decided to put the next order in

How to use it

1. Write your details, your practice and your pharmacy at the top of the sheet.
2. Copy each medicine from its label exactly as printed — name, strength and directions — into the first table.
3. Add the date you started it and who prescribed it, so a new clinician can see how long you have been on it.
4. When something is stopped or changed, fill in the stopped column and the name of whoever made the change, and leave the row where it is.
5. Use the repeat list for the ordering: the date you last ordered, how you ordered, the date you collected and the date you have decided to order again.
6. Take the sheet to appointments, or fill it in on screen and keep it saved in your own browser.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Does the sheet tell me how much to take or when?

No. It has no dose, no timing and no interval printed anywhere. The label column is a blank for copying what is already written on your box or bottle, which is the only instruction you should be following.

Why keep the medicines I no longer take on the list?

Because clinicians ask. Knowing that something was tried and stopped, and when, saves going round the same loop again, and it is the first thing people forget between one appointment and the next.

What should go in the repeat list?

Anything you order again rather than collect once: the item, when you last ordered it, how you ordered it, when you picked it up and the date you have chosen to order next. The sheet does not work that date out for you.

Is this the same as the prescription tracker?

The tracker follows the ordering of many repeat items over months and adds up what you paid for them. This sheet is the list itself — what you take now, what you used to take — with a short ordering table attached.