For each prescription, copy the medication name and strength exactly as printed. Then record how much you actually take and when. Those details may differ from the label, so distinguish between “label says” and “I usually take.” Add the prescriber’s name and specialty if known, the pharmacy, the reason it was prescribed, and the date or approximate time of your last dose. Include medicines you take only occasionally.
Make separate entries for nonprescription pain relievers, sleep products, cold medicines, allergy products, vitamins, minerals, herbal products, workout supplements, nicotine products, and any medicine obtained outside a current prescription. Include injections, inhalers, creams, patches, drops, and implanted or long-acting medicines if applicable. Do not decide that an item is unimportant because it seems routine or unrelated to cocaine use. Let a qualified professional determine its relevance.
- Exact medication or product name, copied from the label when available
- Strength, such as the number of milligrams, if known
- Amount taken and route, such as tablet, inhaled, topical, or injection, if known and applicable statement only after qualified review? [NO]