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    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]
    Note: This list will summarize your home medications, herbs or supplements. Changes made during your appointments at the Center for Diabetes Services are based on information provided by you, your family members, or healthcare team members. It is not meant to substitute advice given to you by your prescribing healthcare provider.