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NNH Clinical Protocol

Medication Sheet

A printable, fillable record of your medications, allergies, and adverse reactions — saved in your browser, ready to print before every visit.

📚 [Primary guideline citation]📄 [Source paper citation]⚠️ For NNH clinical staff only

Step 1

[Picker step title — e.g. Select the procedure / Select the indication]

[One sentence guiding the clinician on what they're choosing.]

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Recommendation

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Choose a different procedure

Clinical decision support, not a substitute for clinical judgment. Verify allergies, drug interactions, and renal/hepatic dose adjustments before administration. [Replace this sentence with protocol-appropriate caveats about evidence quality, regulatory grade, or guideline limitations.]

Reference

[Primary reference — author list. Title in italics. Journal year;volume(issue):pages. doi:...]

[Secondary reference — e.g. relevant society guideline.]

← Take Charge of Your Health

Medication Sheet

Your lifeline against medical errors.

Developed by Craig G. Hurwitz, MD

Why this matters

The most important page in your record

Medication errors send more than 700,000 Americans to the emergency room every year, and most of those errors are preventable. An accurate, up-to-date list of your medications — and your allergies — is the single best defense.

Most patients can't recall their full medication list from memory, and even fewer can list correct doses. That's a problem when you're seen in an ER, switching pharmacies, traveling, or starting with a new provider. Carry one. Print it. Laminate it. Keep it in your wallet.

700K+

ER visits per year from preventable medication errors

~50%

of patients can't accurately list their prescriptions from memory

2 min

to update this sheet every time a med changes

A common scenario

"I had a reaction to a blood pressure medicine — but I don't remember the name."

I hear this all the time. The patient knows something went wrong, but the name is gone. That makes choosing the next treatment tricky — we have to guess at the class of drug and pick around it. Two minutes of writing it down at the time would have spared all of that. Records get lost, doctors retire, offices close — the most reliable place for this information is in your own hands.

How to fill it in

What goes on the sheet

Current medications — include everything you take regularly, including over-the-counter (OTC) drugs and supplements. OTCs can have side effects and can interact with prescriptions. List drug name, dose, how often, what it's for, and the prescribing doctor.

Drug allergies — these are severe reactions: anaphylaxis, severe rash, swelling, breathing trouble, severe nausea or vomiting. If you can describe the reaction, list it. (E.g., "Penicillin — full-body rash.")

Adverse reactions — these are unpleasant but not life-threatening: stomach upset, mild headache, cough. They go in a separate list because the distinction matters when your team is choosing a similar drug.

Update the sheet at every change — new prescription, stopped med, new allergy.
If you're pregnant, trying to conceive, or nursing, flag that on the sheet: many drugs need to be reviewed for safety.
Be honest about alcohol intake. It affects how many medications work and how they're metabolized.

Worked example

Drug	Dose	How often	For	Doctor
Lisinopril	20 mg	Daily AM	Blood pressure	Dr. Smith (PCP)
Atorvastatin	40 mg	Daily PM	Cholesterol	Dr. Smith (PCP)
Metformin	500 mg	Twice daily	Diabetes type 2	Dr. Lee (Endo)
Aspirin (OTC)	81 mg	Daily	Heart protection	Dr. Smith
Vitamin D3 (OTC)	2000 IU	Daily	Bone health	(self)

Allergies — Penicillin: full-body rash · Sulfa: hives. Adverse reactions — Codeine: severe nausea · Atenolol: extreme fatigue.

My Medication Sheet

Northern Nephrology & Hypertension Patient Personal Health Record

Patient name

Date of birth

Last updated

Current medications

Include prescriptions, OTCs, and supplements

Drug name	Dose	How often	What it's for	Prescribing doctor

Drug allergies (severe reactions only)

Anaphylaxis, rash, breathing trouble, swelling

Drug	What happened

Adverse reactions (unpleasant but not severe)

Bad enough that you'd avoid this drug again

Drug	What happened

Pharmacy & notes

Where prescriptions are filled, plus anything else

Primary pharmacy

Pharmacy phone

Notes — pregnancy / nursing status, alcohol intake, anything your team should know

Common mistakes to avoid

Where these sheets fall short

Forgetting OTCs and supplements Aspirin, ibuprofen, multivitamins, fish oil, herbal supplements — all of these can interact with prescriptions and matter to your team.

Brand name vs generic confusion Lipitor and atorvastatin are the same drug. Listing one of them is enough; listing both as separate medications creates confusion.

Vague allergy descriptions "I'm allergic to penicillin" isn't as useful as "Penicillin gave me a full-body rash in 2018." The detail matters when picking similar drugs.

Not updating after changes A stale list is almost worse than no list — it gives false confidence. Update the sheet the day a med changes, not three months later.

Print it. Carry it. Update it.

Hand a copy to every provider you see. Keep one in your wallet. Update it the day anything changes.

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Medication Sheet

[Picker step title — e.g. Select the procedure / Select the indication]

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Reference

Medication Sheet

The most important page in your record

"I had a reaction to a blood pressure medicine — but I don't remember the name."

What goes on the sheet

My Medication Sheet

Current medications

Drug allergies (severe reactions only)

Adverse reactions (unpleasant but not severe)

Pharmacy & notes

Where these sheets fall short

Print it. Carry it. Update it.

For Patients

For Professionals

For NNH Staff

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Office Hours: Mon-Fri 9AM-5PM

© 2026 Craig G. Hurwitz, MD — Northern Nephrology & Hypertension