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Cure4Lupus.org
For Lupus Fighters, By Lupus Fighters.
Promoting Lupus Awareness and Research to Find a Cure.
Providing Information, Support, & Lupus Awareness Products.
Order Online or by Phone 402-718-5002.


Medical Information Sheet

It is a good idea to keep a list of your medications, doctors and other medical information.  It is very helpful when you go to the doctor.  It helps you remember your medications, dosages, etc.  It is also so nice to be able to hand them a piece of paper rather than have to go through the whole list.  You can also keep it in your wallet incase of an emergency.  Below is a template.

MS Word   PDF

NAME    Born: 0-00-0000

Diagnosis List:

In an emergency contact: Name (relationship) phone; address

Allergies: Medications, Foods, Latex, etc.

Current medications:

Medication

Dosage

Frequency

Prescribing Doctor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Doctors:

Primary: Name; Phone (Hospital/Clinic)

Rheumatologist: Name; Phone (Hospital/Clinic)

Pharmacy: Name; Phone (Location)


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