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Medication & Allergy List


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Hi everyone,

Our Dysautonomia community has just finished celebrating Awareness Month this past October. We at DINET wanted to mark this occasion with a small token of our appreciation to our members for their support and participation. We've designed a Medication and Allergy List that you can print out and use at your disposal.

 

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Medication & Allergies List

Name:       ______________________________________________   DOB: ____/_____/_____

Pharmacy: ____________________________________________________________________

Keep your health safe by sharing this list with your doctors and pharmacist. Bring this list to Medical Appointments and keep it with you in case of an emergency. List all current medications (RX & OTC)                                                                                                                           Medication                            Dose / Frequency              Reason/Additional Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Allergies   Medical & Food/Environmental                               Reaction

                  

 

                                                           

 

              

 

 

 


 X:__________________________________________________           Date Updated: ________________________________

*For information & Resources on Dysautonomia and POTS, please visit www.dinet.org

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