Medication list template
A current list of every medicine you take.
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How to make a medication list form
- 1
Check the questions: rename, add or delete any field, or change how it’s answered.
- 2
Add your organisation’s name, a contact line and your logo if you like.
- 3
Choose fillable PDF, printable PDF, Word or HTML, and the paper size.
- 4
Download the medication list form and share it, print it or add it to your website.
About this medication list form
A medication list records every medicine you take: prescription medicines, over-the-counter tablets, vitamins and herbal supplements, with the dose, when you take it, what it’s for and who prescribed it. Doctors, pharmacists and emergency teams use it to avoid harmful interactions and missed doses.
Keep one for yourself and for anyone you care for, update it whenever something changes, and take it to every appointment. Everything you type stays on your device: the form is built in your browser and nothing is uploaded.
What’s on the medication list form
The template has 3 sections and 8 questions. Every one can be renamed, moved or deleted.
- Details: Name; Date of birth; Updated on; Doctor and phone; Pharmacy and phone; Allergies to medicines
- Medicines: Medicines table (Medicine and strength, Dose, When (morning / noon / night), What it’s for, Prescribed by, Start date)
- Stopped medicines: Stopped table (Medicine, Stopped on, Why)
Tips
- Write the exact name and strength from the packet (e.g. “Metformin 500 mg”).
- Include supplements and creams; they can interact too.
- Note the date you updated the list at the top.
Four ways to save it
A fillable PDF has typing boxes, tick boxes and choices built in. A printable PDF gives clean boxes and writing lines for pen and paper. The Word file can be edited further, and the HTML code adds the same questions to a website. Browse more form templates, or design a completely different layout in the custom form builder.
Frequently asked questions
Should I include vitamins and supplements?
Yes. Some supplements interact with prescription medicines, so doctors and pharmacists need to know about them.
Where should I keep my medication list?
One copy in your wallet or bag, one at home where carers can find it, and a photo or PDF on your phone.
Can people fill in this medication list form on a phone?
Yes. Choose “Fillable PDF” and send the file. It opens in the Files or Drive app on Android, Files on iPhone, and any browser on a computer, where people can type their answers and save the result.
Can I put the medication list form on my website?
Yes. Choose “HTML” to copy ready-made form code with labels and a simple style. Set the form’s action to the address that should receive submissions, such as your own form handler.
Is anything I type sent to a server?
No. The editor runs in your browser and builds the file on your device. Atifo has no server that could receive your form or the answers on it.
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