A blank list for keeping prescription medicines, over-the-counter medicines, vitamins, and supplements in one place. Record the name and strength, when and how much you take, why you take it, and recent changes. Bring the list to medical and pharmacy visits. You do not need to enter or transmit personal health information to this website; use the print/PDF button to save a blank form and fill it in yourself.
Why keep a medication and supplement list?
A useful medication list includes more than prescriptions. Over-the-counter medicines, vitamins, minerals, herbal products, dietary supplements, and medicines taken only as needed can all be relevant during a clinical review.
FDA and AHRQ recommend keeping a current list with the medicine name, strength, reason for use, and instructions for when, how, and how much you take, then updating it whenever a medicine is started, stopped, or changed.
Medication and supplement list
| Type | Name and strength | Dose, frequency, and timing | Reason for use | Start / change date | Notes |
|---|---|---|---|---|---|
For type, you might write prescription / OTC / vitamin or supplement / herbal product / as-needed medicine. When a product has several ingredients, copy the label or prescription information rather than guessing.
Useful information to keep with the list
- Date last updated, so you know when the list was reviewed.
- Drug, food, or other allergies and previous reactions, including what happened.
- Pharmacy or health-care locations when medicines come from more than one place.
- As-needed medicines, even if they are not taken every day.
Checking the list with family
Date checked together with family: __________
In the existing Notes column, separate what the person knows from what needs confirmation. Check medicine names, strengths, and doses against medicine packets or prescriptions when recording them. If sources differ or something is unclear, do not guess: note a question for a clinician or pharmacist. Do not change a dose or stop a medicine on the basis of this record.
Write your chosen items on paper or in a personal document you control. This section has no feature for entering, uploading, transmitting, or storing health information.
Respect the person’s wishes and privacy, and share only what they allow. These notes do not grant access to information or authority to make decisions for someone else, and do not replace the consent or authorization documents required by the institution. Check any required procedures and documents with the institution.
The existing blank-sheet print button does not include these added family-visit notes. Copy them onto paper or into a personal document, or print the full page from your browser. If a table is cut off, choose landscape orientation.
Four checks before an appointment
- Note any medicine or supplement that was recently started or stopped.
- Write down any change in dose, frequency, or timing.
- Record new symptoms or problems that appeared after a medication change.
- Write your questions before changing or stopping a medicine on your own.
Questions to bring to a visit
What is each medicine for? _________________________________________
Could any of my medicines, supplements, or foods interact? __________________
When should timing or use be changed or reviewed? _________________________
Could a new symptom be related to a medicine or supplement? __________________
Does this replace the prescription label or medication bottle?
No. This is an organizing aid. If your handwritten list differs from a prescription, pharmacy label, or product label, use the source information and confirm discrepancies with a clinician or pharmacist. Do not guess the ingredient of a combination product.
Should supplements be included?
Yes, when possible. FDA advises including vitamins and dietary supplements alongside prescription and nonprescription medicines. Some supplements can interact with medicines or matter before tests and procedures, so the list helps you disclose what you actually take.
Keeping the list current
Update the date whenever something changes so old versions do not become confusing. You can keep a paper copy in a wallet or bag, or save the blank form as a PDF and keep an updated copy on your phone for appointments or emergencies.
Related resources
Health records and visit preparation · Blood pressure and lab results log · Lab result guide
- FDA: Create and Keep a Medication List for Your Health
- AHRQ: How To Create a My Medicines List
- MedlinePlus: Make the most of your doctor visit
Editorial check: 27 September 2026. General health information and a blank self-record form; not a diagnosis, prescription, or medication-change instruction. No independent clinician review has been performed.