Family Road Map Guide
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Medication Log<br />
This chart helps keep information on medicines in one place. Keep an updated version in your binder to bring to appointments and use when talking to doctors by<br />
phone. Put a copy inside the medicine cabinet or lockbox to use when you refill weekly pill containers. Make sure the school, each of your child’s doctors, and all<br />
caregivers have an updated version of this list.<br />
Child’s name: Last updated:<br />
Pharmacy name/Ph. #:<br />
Name of Medication Total Dosage<br />
(Example: 40 mg)<br />
Date Rx started Date Rx stopped Directions: How Much/When/Special<br />
instructions<br />
(Example: 20 mg tablet morning, 20 mg<br />
tablet evening/Take with food/Avoid sun)<br />
Prescription ID<br />
Number<br />
Doctor/NP’s Name/<br />
Phone Number<br />
Over-the-counter (non- prescription) medicines, vitamins,<br />
and herbs (including amounts and when taken):<br />
Special notes for teachers and caregivers (other instructions,<br />
side effects to watch for, what to do if side effects are<br />
observed):<br />
<strong>Family</strong> <strong>Road</strong> <strong>Map</strong>: A Step-By-Step <strong>Guide</strong> to Navigating Health, Education, and Insurance Services for Families with Special Needs. Copyright © 2017, Melton Hill Media, LLC. All rights reserved.<br />
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