Your complete medication history is important to your physicians and to the hospital. Please fill out this form and bring it with you anytime you go to the doctor’s office or to the hospital. If you are scheduled for a Pre-Surgical Services appointment, make a trip to the Emergency Room, or are coming directly to the hospital, remember to bring this completed form!!
If for some reason you are unable to fill out this form, please bring in a bag all of the medications (in their original containers) that you are currently taking.