MEDICINES INFORMATION — PRIVATE ORIGINAL PREPARATION RECORD
Checked date:
Product name exactly as labelled:
Form and label strength, including units:
Actual amount/timing under current instructions:
Reason / who recommended it, if known:
Source: container / current instructions / old list:
Unclear or conflicting detail:
Question for pharmacist/midwife/doctor:
Answer and which record should be updated:
Include actual prescription, shop-bought, herbal, homeopathic and other products to discuss.
This record never selects a product or changes a dose.