Medication name (brand name AND generic name)
Prescribed dosage (mg, ml, or units as prescribed)
Form (tablet, capsule, liquid, patch, injection, inhaler, eye drops, cream)
Frequency (once daily, twice daily, as needed, etc.)
Time of day (morning, with lunch, bedtime, specific clock times)
Taken with/without food (as directed)
Prescribing physician (name and contact)
Pharmacy (name, phone, prescription number)
Date started (when this medication was first prescribed)
Purpose (what condition this medication is for, as stated by the physician)
Refill information (refills remaining, next refill date, auto-refill status)
Special instructions (crush allowed, refrigerate, take with full glass of water, etc.)
Known allergies and adverse reactions (medication name, reaction type, severity)
Discontinued medications (name, date stopped, reason per physician)
Over-the-counter medications and supplements taken regularly (include vitamins, herbal supplements)