Planning Ahead - Florida Developmental Disabilities Council

CURRENT PHYSICIANName Profession Phone Number Date Last SeenPrimary physicianDentistOptometrist/OphthalmologistSpecialists and other health care providers (speech/physical therapist, nutritionist, nurse practitioner, psychologist,etc.):List:ALLERGIES (Food, Medicine or Substances)When an allergic reaction occurs, this is what happens, and this is what should be done:Non-prescription (over-the-counter) medicines taken for headaches, colds, constipation, skin problems, indigestion,etc. Indicate whether as needed or regularly and for what condition:Able to take medication without assistance: Yes NoDescribe assistance needed or special way required (e.g. crushed, with food, etc.):Knows names of own medication: Yes NoRecognizes own medications: Yes NoKnows purposes of own medications: Yes NoPRESCRIPTION MEDICINESLook at the bottles of medicines now being taken for the following information. Copy this information on theform provided on the following page.70 Section 2, The Personal Information Section