Printable · A4 and US Letter
My medication list
One page with your allergies, pharmacy and every medicine, vitamin and supplement you take. Hand it over at the appointment instead of reciting it.
- Free
- No sign-up
- 1 page
- Black-and-white friendly
Last reviewed 13 Oct 2026 · RisuLabs
My medication list
Bring this to every appointment. Update it when anything changes.
Name
Date of birth
Date updated
Allergies
Pharmacy and phone
Emergency contact
Phone
Medicines, vitamins and supplements
| Medication | Dose | When I take it | What it is for | Prescriber |
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How to use it
- List everything you take. Include prescriptions, vitamins, supplements and anything bought over the counter. Check the label for the dose.
- Add allergies and contacts. Write your allergies, your pharmacy and an emergency contact at the top.
- Bring it and update it. Hand a copy to every doctor or pharmacist. Cross out and rewrite when something changes.
What is on the sheet
- Name, date of birth and date updated
- Allergies, pharmacy and emergency contact
- Eleven rows: medicine, dose, when, what for, prescriber
- Room for vitamins and supplements
Want it to write itself?
Oclo exports your medicines and the last 30 days as a PDF for your appointment. Free, no account.
Questions
Can I edit it before printing?
The PDF has blank lines to fill in by hand. Nothing you write is sent anywhere.
What about medicines I take twice a day?
Use one row per dose time, for example Metformin 8:00 and Metformin 20:00, and put the time in the When I take it column.
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