Because Somerset Medical Center is committed to improving patient safety, it has created a form to help you and your family track the medications you are taking - from prescription and over-the-counter medications to herbals and vitamins. This document is designed to provide physicians and other health care providers with a current list of all of your medicines. By sharing this form with your providers, you become an active participant in the health care team.

My Personal Medication Record PDF Form - Click on the form, type in your information online and print it out or print the form and complete it using a pen. Include as much information that you can, and be sure to complete a form for every member of the family. Once you have completed and printed out the form, keep it with you at all times. Don't have Adobe Reader? Get it free.

• Mi registro personal de medicamentos

Tips for Being an Active Member of Your Health Care Team

• Bring this list of your medicines each time you go to the hospital, your doctor or pharmacy.
• Update the list as needed.
• Make sure your health care providers know everything that you are taking, including prescription and over-the-counter medicines and dietary supplements such as vitamins and herbs.
• Make sure your providers know of any allergies and reactions you have had to medicines.
• When you receive a new prescription, make sure you understand what it’s for and ask for information about the medication in terms you can understand.