For every prescribed medication, write the name exactly as shown on the container, the strength, how it is currently taken, who prescribed it, the reason it was prescribed, and the last time it was taken. Add over-the-counter medicines, supplements, and medications obtained from another person or source. Note missed doses, taking more than directed, combining substances, and abrupt changes, but do not use the worksheet to design your own taper or medication plan. A qualified professional should address medication decisions.
Create a separate substance timeline. Include alcohol, cannabis, nicotine, illicit substances, and any prescription medication used differently than directed. Record approximate amount, route, frequency, last use, longest recent period without use, and any serious reactions or prior withdrawal concerns. Mention allergies, chronic health conditions, pregnancy when relevant, and previous medication reactions. Accuracy matters more than presenting a tidy story. If you do not know an amount, provide the best range you can and label it as an estimate.
- Medication name, strength, current use, prescriber, purpose, and last dose
- Over-the-counter products, supplements, allergies, and adverse reactions
- Alcohol, cannabis, nicotine, illicit substances, and prescriptions used differently than directed