Page 7 - Liver patient passport
P. 7
Please use the table below to list ALL of the
medications you are taking. These include both
prescription and non-prescription.
Pharmacy name and address:
Allergies:
Medication Condition When do I take it? Start Stop
Name Dose I take it for Morning Noon Evening Bed date date Doctor Special instructions
Non-prescription medicines: (also known as ‘over-the-counter’ medicines) – medicines
that you can buy without a prescription from your doctor. These include vitamins, herbal
medications, pain relief medications, dietary supplements and cough and cold medications.
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