medications

ASK Self-Help Group, medication record

"Remember-to be successful, keep it honest, focused and most of simple".

HELP YOUR MEDICATION(S) WORK FOR YOU

Keep a daily log on the medication you are taking.

Today's date:____________________________

Name of your medication(s). Generic or regular brand:__________________________

_____________________________________________________

Number of milligrams:_________________________________________________

Your daily dosage:___________________________________________________

How are you feeling as a result of the medication at any given time during the day:

_________________________________________________________

_________________________________________________________

_________________________________________________________

Side effects:________________________________________________

_________________________________________________________

_________________________________________________________

How is your mood in the evenings:____________________________________________

_________________________________________________________

_________________________________________________________

What are your sleeping patterns:____________________________________________

_________________________________________________________

_________________________________________________________

What skills do you want to improve: ____________________________________________

_________________________________________________________

_________________________________________________________

What improvements are you seeing :____________________________________________

_________________________________________________________

_________________________________________________________

top | next | table of contents

home | about me | diagnosis | behaviors | faqs | personal stories | parenting
education | workplace | articles | humor | resources | send page