Your Medicine: Be Smart. Be Safe. Medicine Wallet Card You can learn more about how to take medicines safely by reading this guide. It answers common questions about getting and taking medicines and has handy forms that will help you keep track of information. Show this card to your doctor or pharmacist. To print more copies, visit www.ahrq.gov and type "Your Medicine" in the search box.Select to download the print version ( PDF version - 1.1 MB ). Plugin Software Help.My name ___________________________________Contact information _________________________________________________________________________________________________________________Prescription MedicinesName and How Much MedicineColorWhat It Is ForDate Began TakingHow Much To Take and WhenDo Not Take With(example)Tetracycline250 mgWhiteRespiratory infection2/8/20111 tablet4 times a day9 a.m., 1 p.m.,5 p.m., 9 p.m.Antacids or dairy products Blood type: ________________________________Medical conditions: __________________________________________________________________________________________________________________________________________________________________________________________________Emergency ContactName: ___________________________________Home phone: ______________________________Work phone: _______________________________Cell phone: ________________________________Nonprescription medicines___ Cold or cough medicines___ Aspirin or other pain relievers___ Allergy relief medicines___ Antacids___ Sleeping pills___ Laxatives___ Diet pills___ Other: ________________________________________________________________________________________________________________________________________________________________________________________________Medicines I should not take because of bad reactions or allergies: ______________________________________________________________________________________________________________________________________________________Vitamins, herbals, and supplements___ Vitamins (type): ___________________________________________________________________________________________________________________________________________________________________________________________ Glucosamine chondroitin___ St. John's wort___ Ginkgo biloba___ Ginseng___ Other: ________________________________________________________________________________________________________________________________________________________________________________________________Return to Document Current as of April 2011 Internet Citation: Your Medicine: Be Smart. Be Safe. Medicine Wallet Card. April 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/safemeds/walletform.html
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