Use the form on the next page to write your medicines down and carry it in your
wallet so you have it when you need it.
Talk to your doctor, nurse or pharmacist if you have any questions about
your medicines or how to take them.
2/2006. Developed through a partnership of The Ohio State University Medical Center, Mount Carmel Health and
OhioHealth, Columbus, Ohio. Available for use as a public service without copyright restrictions at
www.healthinfotranslations.com.