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QualityTool

The Med Form


Description

This form helps patients and their family members track medications they are taking, including prescription medications and over-the-counter medicines, plus herbal supplements and vitamins. This form is designed to provide physicians, hospitals, pharmacists, home health agencies, and others with a current list of all of a patient's medicines. By sharing the Med Form with providers, patients become active participants in the health care team.
Links to the Tool:
This tool is available at: http://www.azhha.org/patient_safety/documents/MedFormEnglish.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software External Web Site Policy.)
This tool is available in Spanish at: http://www.azhha.org/patient_safety/documents/MedFormSpanish.pdf

Developer

Arizona Hospital and Healthcare Association; Arizona Medical Association; Arizona Partnership for Implementing Patient Safety; Health Services Advisory Group

Funding Sources

Arizona Hospital and Healthcare Association; Arizona Medical Association; Arizona Partnership for Implementing Patient Safety; Health Services Advisory Group


QualityTool Topic

Patient/Medication safety


History

  • Release Date: 01/2006
  • Original Summary: 07/2009
Disclaimer: The inclusion of a tool in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality or Westat of the tool or of the submitter or developer of the tool. Read more.
QualityTool Classification

Stage of Care:
Setting of Care:
IOM Domains of Quality:
QualityTool Format:
QualityTool Topic:

Last updated: May 26, 2010.