Medication Interview Forms

These standardized forms facilitate the systematic collection of medication history and ensure no important detail is overlooked.

Here's a diagram illustrating the Medication Interview Forms:

Typically, a medication interview form might contain:

1. Patient Details:

• Name, age, gender, weight, height, and other demographics.

2. Prescription Medications:

• Name of the drug

• Dose and dosage form (tablet, liquid, injection, etc.)

• Frequency and timing of administration

• Indication or reason for the medication

• Duration of therapy

• Prescribing physician
  

3. Over-The-Counter (OTC) Medications:

• Similar details as prescription medications, but also ask about the reason for taking these medications, as they might indicate undiagnosed or untreated conditions.

4. Herbal/Dietary Supplements:

• Name of the supplement

• Reason for use

• Duration of use

• Any perceived effects or side effects

5. Allergies:

• Specific details about any known drug allergies or sensitivities, including the type of reaction experienced.

• Allergies to food, dyes, or other substances.

6. Vaccination History:

• Details about recent or relevant vaccinations.
  

7. Pharmacy Details:

• Preferred or regular pharmacy, which can be useful for cross-referencing information or communicating about medication changes.

8. Past Medication Issues:

• Any past problems with medications, including side effects, non-adherence issues, or therapeutic failures.

9. Lifestyle & Habits:

• Information on alcohol consumption, tobacco use, or recreational drug use, as these can affect medication therapy.

10. Review:

• A section for the pharmacist to note findings, potential issues, recommendations, or follow-up actions required.