Medicine Wallet Card

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My name ___________________________________
Contact information ___________________________
___________________________________________
___________________________________________

Prescription Medicines

Name and How Much Medicine	Color	What It Is For	Date Began Taking	How Much To Take and When	Do Not Take With
(example) Tetracycline 250 mg	White	Respiratory infection	2/8/2011	1 tablet 4 times a day 9 a.m., 1 p.m., 5 p.m., 9 p.m.	Antacids or dairy products

Blood type: ________________________________

Medical conditions: __________________________
__________________________________________
__________________________________________
__________________________________________
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Emergency Contact

Name: ___________________________________
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: ________________
___________________________________________________________________
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Vitamins, herbals, and supplements

___ Vitamins (type): __________________________________________________
___________________________________________________________________
___________________________________________________________________

___ Glucosamine chondroitin
___ St. John's wort
___ Ginkgo biloba
___ Ginseng
___ Other: __________________________________________________________
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