Each time you go to a medical appointment, regardless of the speciality, you should inform the physician of the updated list of medication, thus avoiding prescription of medication potentially causing side effects or overdose. The medication list should include both prescriptions and over-the-counter medicines so that the physician knows exactly what medication you are taking.

Name:                                                                Data de nascimento__/__/__

Medications		Breakfast	Lunch	Dinner	At bedtime	Observations
Pantoprazol 40 mg	ES	1 pill
Lasix 40 mg	ES	1 pill
Bisoprolol 2,5 mg		1 pill
Tromalyt 150mg	AM		1 capsule
Centrum			1 pill
Adalat CR 60 mg				1 pill
Lorazepam 2,5 mg					1/2 pill

Notes: ES – empty stomach; AM – After meal;

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