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Keywords: healthcare free daily medication management form free medication manager medication schedule doctor medicine prescription otc pharmacy drug store medical supplies medical equipment getting the right medications at the right times each day drug interaction checkers medication scheduling medication schedule free public domain

Medication Manager
"Getting the right medications at the right times each day."

MyMedicationManager.com

By Rev. Bill McGinnis, Director - Internet Church Of Christ - LoveAllPeople.org
With help from his sister, Elisabeth Bulloch

This web page is intended for in-home medical patients and their caregivers. It provides a simple, reliable way to make sure that the right medications are taken at the right times each day. Medication mistakes are a serious problem for many patients, because it is very easy to get all mixed up on which medications to take, and when. We hope this web page helps to solve this problem.

This page has three parts:

1. The Blank Form, which you can modify to schedule your own medications for each day. You can either use your computer to modify the Blank Form's text, or you can make copies of the Blank Form, then write in your own information, then make copies of your Filled-Out Form, one copy for each day.

2. An actual Filled-Out Form, which gives you a good example of how you can modify the Blank Form to schedule your own medications.

3. Links to three different Drug Interaction Websites, which will tell you if the medications on your list are safe to take together.

1. The Blank Form

You can download the Blank Form here => Daily Medication Manager Form or you can copy the text below. Change it however you like, to make it work best for you. (See example in part 2, below.)

DIRECTIONS TO THE PATIENT (or caregiver, as appropriate):

1. Fill in the name and the date at the top of the Blank Form.

2. Fill in the times and the medications to be taken at each time. (See example in the Filled-Out Form, part 2, below.)

3. Keep your medications, your Filled-Out Form, and a pen or pencil all together in the same place, near a clock you can read.

4. When you do actually take each medication, place a check-mark beside it, indicating that the medication actually was taken. And also write down the exact time you took it. Do this for each medication at each time. It is very easy to forget if you actually took it or not, so be sure to make a check-mark ONLY WHEN YOU ACTUALLY DO TAKE THE MEDICATION. This way, you will get all of your medications as needed, and you won't be trying to remember if you really did take each medication or not.

      
                        DAILY MEDICATION MANAGER


PATIENT NAME:  _________________________________  DATE: _______________


TIME "A" (                )

   Med 1 _________________________________________________________

   Med 2 _________________________________________________________

   Med 3 _________________________________________________________

   Med 4 _________________________________________________________

   Med 5 _________________________________________________________


TIME "B" (                )

   Med 1 _________________________________________________________

   Med 2 _________________________________________________________

   Med 3 _________________________________________________________

   Med 4 _________________________________________________________

   Med 5 _________________________________________________________


TIME "C" (                )

   Med 1 _________________________________________________________

   Med 2 _________________________________________________________

   Med 3 _________________________________________________________

   Med 4 _________________________________________________________

   Med 5 _________________________________________________________


TIME "D" (                )

   Med 1 _________________________________________________________

   Med 2 _________________________________________________________

   Med 3 _________________________________________________________

   Med 4 _________________________________________________________

   Med 5 _________________________________________________________


TIME "E" (                )

   Med 1 _________________________________________________________

   Med 2 _________________________________________________________

   Med 3 _________________________________________________________

   Med 4 _________________________________________________________

   Med 5 _________________________________________________________


TIME "F" (                )

   Med 1 _________________________________________________________

   Med 2 _________________________________________________________

   Med 3 _________________________________________________________

   Med 4 _________________________________________________________

   Med 5 _________________________________________________________



     
Form Written by Rev. Bill McGinnis, Director - LoveAllPeople.org
PUBLIC DOMAIN

For complete information about this form, please see 
MyMedicationManager.com

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2. A Filled-Out Form, To Use As An Example

After you take each medication, you should place a check-mark beside it, to show that you have really taken it. If you take any other medication(s), you can write it in. This gives you an accurate record of all the medications you have taken each day. And if you see a new doctor or go to the hospital, they will want to know what medications you are taking; and you can give them your filled-out Medication Manager Form.
      
                        DAILY MEDICATION MANAGER

PATIENT NAME: William McGinnis            DATE: _______________

TIME "A" (4:00 AM)
   Med 1 __ Cipro (500 mg) (Heavy-duty anti-biotic)

TIME "B" (MORNING - 6:00-9:00 AM)
   Med 1 __ Avodart (.5 mg)(Prostate reducer)
   Med 2 __ Sanctura (20 mg) (Anti bladder spasms)
   Med 3 __ Centrum Silver (Multi-vitamin)
   Med 4 __ Azo Standard (2 pills) (Urinary analgesic)

TIME "C" (NOON-TIME)
   Med 1 __ Cardura (4 mg) (Vaso-dilator)
   Med 2 __ Aspirin (325 mg) (Blood thinner/heart protection)
   Med 3 __ Ducosate Sodium (100 mg) - (Stool softener)

TIME "D" (4:00 PM)
   Med 1 __ Cipro (500 mg) (Heavy-duty anti-biotic)

TIME "E" (EVENING 6:00-8:00 PM)

   Med 1 __ Sanctura (20 mg) (Anti bladder spasms)
   Med 2 __ Azo Standard (2 pills) (Urinary analgesic)
   Med 3 __ Ducosate Sodium (100 mg) - (Stool softener)

TIME "F" (MIDNIGHT/BEDTIME)
   Med 1 __ Cardura (4 mg) (Vaso-dilator)
   Med 2 __ Aspirin (325 mg)(Blood thinner/heart protection)
   Med 3 __ Ducosate Sodium (100 mg) - (Stool softener)
   Med 4 __ Lisinipril (20 mg) (ACE inhibitor/blood pressure)
   Med 5 __ Lipitor (20 mg) (Anti-cholesterol) 
   Med 6 __ Azo Standard (2 pills) (Urinary analgesic)

Form Written by Rev. Bill McGinnis, Director - LoveAllPeople.org
PUBLIC DOMAIN

For complete information about this form, please see 
MyMedicationManager.com



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CARETAKERS AND OTHER HEALTH CARE PROVIDERS:

Please don't dismiss this form just because it is simple. The fact is: faulty administration of medications is one of the most important preventable causes of needless health problems in senior citizens. Frequently, they have multiple meds and impaired ability to deal with them: maybe they can't see very well, or they get confused, or they lose things, or they simply get frustrated and quit trying to keep their meds organized very well. The result is that they miss certain meds, and take others at the wrong time, randomly.

And some of the very people who are most endangered are those for whom simplicity is an absolute requirement!

For such people, this simple form may be exactly what they need. A helpful relative or other caregiver can fill out the form correctly and make copies for each day of the month. Then, all the patient needs to do is find the page for today and, step-by-step, work through the day's medication schedule, making a check mark beside each medication as it is taken.

Sure, anybody who thinks about it for two minutes could make a form just like this. So these people can make their own, if they like. Everybody else can use this form, changing it however they want to change it. (That's why it's Public Domain: you can do anything you want with it.)

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You might also want to see the Timex Daily Medication Manager, which works well with the Daily Medication Manager Form.

3. Links To Drug Interaction Websites
To see if your medications are safe to take together.

The Drugstore.com Drug Interaction Checker.

The Drugs.com Drug Interaction Checker

The MedScape.com Drug Interaction Checker - (Requires free registration.)


Blessings to you. May this Medication Manager help you to take your medications properly and regain your health.

      Rev. Bill McGinnis

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Blessings to you. May God help us all.

       Rev. Bill McGinnis, Director - LoveAllPeople.org

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