The medicines you take are a very important part of your health information.
Information such as your prescription drug name, strength, and directions for taking it will help your physician provide the best care for you.
Please print this
UWMC Patient Medication History Form and fill it out or have your caregiver complete it. Please bring the completed list of your current medications (and/or your bottles) to your visit and discuss it with your UW Medical Center medical provider.
If you need more space to list your medicines, copy this form or use a blank piece of paper.