Medication Or Supplements
These are the questions you will be asked on the Medication Or Supplement List.
For a print friendly version, see: Medication/Supplement List [PDF version]. (56KB)
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- Approx. Date Started
- Medications: Please list diabetes medications first, including insulin, then all others
- Dose: (mg or units)
- How many pills at one time?
- How often taken each day? (Once, twice, etc.)
- Time of the day taken (before or with meal; etc.)
- What allergies do you have to medicine? [None / Other]
- What is your pharmacy name, address and phone number?
- Mail order pharmacy (if used) name, phone number, and for which meds/supplies?
- How many times a week do you miss or skip medication(s)?
- What concerns do you have about your medication? [Schedule / Finances / Side effects / Other]