Health Literacy Universal Precautions Toolkit, 2nd Edition

Health Literacy Universal Precautions Toolkit, 2nd Edition

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My Medicines

Name __________________________________________________    Date ________________________ 

Pharmacy Name __________________________________________________    Pharmacy Phone ________________________ 

Doctor Name __________________________________________________    Doctor Phone ________________________ 

 

Medicine Amount of medicine (e.g. number of pills)
Brand Name Generic Name Amount (mg) Morning Midday Evening Night Time Special Instructions
               
               
               
               
               
               
               

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Page last reviewed February 2015
Page originally created February 2015
Internet Citation: Health Literacy Universal Precautions Toolkit, 2nd Edition. Content last reviewed February 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool16a.html