Medication Chart


Medication Chart

I created a number of charts to help record important information needed during the process of treating a mental illness.  Charts to easily record:

  1. Contact Information of Medical Providers
    An address book page to enter Doctor, Psychiatrist, Therapist, Crisis Hotline and others’ information:
    Street Address
    City, State  Zip
    Phone Number (s)
  2. Monthly Calendar for Appointment Setting
    A critical part of recovery is knowing when appointments are.  A one page calendar month to enter appointments, an ideal companion to the Contact Information page for canceling or rescheduling.  It is designed Monday – Sunday.
  3. Daily Tasks & Goals
    Each line ending with a check off box.  Print 7 of these to track a week’s worth of activity.  This can help expose ways to change day-to-day functioning.
  4. Diagnoses
    A place to notate outcomes of appointments or lab testing with Medical Providers.  For example, on January 1st met with Dr. Collins for an examination resulting in the diagnoses of Major Depression.
  5. Recommendations
    A place to track important advice from each Medical Provider.   For Example:
    Jan. 1st, Therapist recommends to assign oneself a single task to complete each day.
    Feb.2st, Primary Doctor recommends walking every other day.
    March 3rd, Psychiatrist recommends increasing medication dosage.
  6. Medication
    Very important to have a list of Medications that are being taken.  More important is being able to easily advise each Medical Provider a history of your Medications.  A list you can share with the Primary Doctor, Psychiatrist, Therapist, Pharmacist, Specialty Providers (ex. Gynecologist).
  7. Vitamins/Supplements
    Supplements are also very important to share with your Medical Providers.  Make certain that a mixture of a Supplement and the Medication do not interact with each other, diminish the effect of another, or have a dangerous/toxic reaction in the body!
  8. Nutrition/Allergies
    A chart to record the types of food consumed.  What you are allergic to.  Also, what you are not allowed to eat due to Medication requirements.
  9. Exercises
    Last but not least is a chart to record ideas to incorporate physical and mental exercises into your life.

KnowMental offers various self-monitoring forms to assist you while in therapy.
CLICK HERE to access a FREE download of this tool and more…

Preview of Medication Charts:

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