| Medication Log | |||||||||||||
| Name | Date | ||||||||||||
| Name of Medication | Date Started | Date Stopped | Dosage, Dosage Times | Special Instructions | Purpose | Size, Shape, Color | Prescribing Physician | Physician Phone Number | Side Effects? | Refill Number | Pharmacy Phone Number | ||
| Lovastatin 40mg Lovastatin 40mg | Daily Daily | Cholesterol Cholesterol | |||||||||||
| Advair Inhaler Advair Inhaler | Twice Daily Twice Daily | ||||||||||||
| ASA 325g (Aspirin) ASA 325g (Aspirin) | Daily Daily | ||||||||||||
| Septra DS Tablet Septra DS Tablet | Twice Daily Twice Daily | for 3 days for 3 days | |||||||||||
| Coreg/Carvedilol 6.25mg Coreg/Carvedilol 6.25mg | Q 12 hours Q 12 hours | 8:00 AM & 8:00 PM 8:00 AM & 8:00 PM | |||||||||||
| Prinivil/Lisinopril 2.5 mg Prinivil/Lisinopril 2.5 mg | Daily Daily | ||||||||||||