My Health Journal

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Medication & Prescription Tracker

Tracker

Keeping our family healthy, one dose at a time.

Family Member:Medical Conditions:Date of Birth:Primary Doctor:Phone:Insurance Provider / ID #:Allergies:Emergency Contact & Phone:

Medications

Medication name	Strengthmg / mcg / ml	Dose	How often	Reason / taken for	Prescribing doctor	Date started	Date stopped	Refills remaining

Pharmacy & refills

Rx number	Pharmacy	Side effects / reactions	Special instructions	Next refill due	Notes

Reminders

Take medication as prescribed by your doctor.
Do not stop any medication without talking to your doctor.
Keep an up-to-date list of all medicines you take.
Store medicines safely and out of reach of children.
Check expiry dates regularly.
Refill prescriptions before running out.

Important notes