Personal medicine tracker

Indiana University Health Plans is a Medicare Advantage organization with a ... Enrollment in Indiana University Health Plans depends on contract renewal.
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Personal medicine tracker Complete this form in pencil (your medicines may change) and take it with you to your next visit with your healthcare team. Use it as a guide for asking questions about your medications. Additional copies are available at iuhealthplans.org > Tools & Resources. Pharmacy name: Name of medicine

Why you take it

Pharmacy phone:

How much When you you take take it

Side effects

Date started

Date stopped

Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Enrollment in Indiana University Health Plans depends on contract renewal. Other pharmacies/ physicians/providers are available in our network. Product types include HMO and HMO POS. © 2018 IUHealth 6/18 IUH#27351

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Non-prescription medicines and dietary supplements (Vitamins, minerals, herbal supplements, other substances) Name

Why you take it

How much When you you take take it

Side effects

Date started

Date stopped

Tips for remembering to take medicines Timing Take your medicines at the same time(s) every day.

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Link timing with something you do around the same time(s) every day, such as brushing your teeth.

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Place a refill reminder on your calendar a week before the medicine is due to run out.

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Get support Ask friends or family to help remind you when it’s time for your next dose. You can remind each other.

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Helpful tools Keep a calendar or daily chart to write down when you take your medicines.

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Put a reminder on your refrigerator, medicine cabinet or bathroom mirror.

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Set a reminder alarm on your smartphone or computer.

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Use an electronic pill dispenser with dispensing alarms (available at drugstores).

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ATTENTION: Our Customer Solutions Center has free language interpreter services available for non-English speakers. Call 800.455.9776 (TTY: 800.743.3333). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 800.455.9776 (TTY: 800.743.3333). 注意:如果您使用 繁體中文,您可以免費獲得語言援助 服務。請致電 800.455.9776 (TTY: 800.743.3333). IU Health Plans complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. IU Health Plans cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. IU Health Plans 遵守適用的聯邦民權法律規定,不因種族、膚色、民 族血 統、年齡、殘障或性別而歧視任何 人.

© 2018 IUHealth 6/18 IUH#27351

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