Medication List and Change Log Template
Use this template to track current medications, OTC products, supplements, allergies, medication changes, and refills.
A medication list should be current, portable, and easy for a doctor, pharmacist, emergency responder, or backup caregiver to understand.
Quick answer
Use this template to track current medications, OTC products, supplements, allergies, medication changes, and refills.
Current Medication List
| Medication | Dose | Time | Reason | Prescriber | Pharmacy | Notes | | --- | --- | --- | --- | --- | --- | --- | | | | | | | | | | | | | | | | | | | | | | | | |
Over-The-Counter Medicines And Supplements
| Item | Dose | Frequency | Reason | Notes | | --- | --- | --- | --- | --- | | | | | | | | | | | | | | | | | | |
Allergies And Reactions
| Allergy | Reaction | Severity / notes | | --- | --- | --- | | | | | | | | |
Medication Change Log
| Date | Medication | Change | Who changed it? | Why? | What to watch | Follow-up | | --- | --- | --- | --- | --- | --- | --- | | | | | | | | | | | | | | | | |
Refill Tracker
| Medication | Refill due | Pharmacy | Who owns refill? | Backup | | --- | --- | --- | --- | --- | | | | | | | | | | | | |
Kefiw Tip
Add a last verified date at the top of the list.
A medication list without a date can be dangerous because no one knows whether it is current.
Questions To Ask At Appointments
- Is this list accurate?
- Are any medications duplicates?
- Are any no longer needed?
- Could any cause dizziness, confusion, sleepiness, constipation, or falls?
- Are there interactions with OTC medicines or supplements?
- Can refills be synchronized?
- Can timing be simplified?
Red Flags
- More than one medication list exists.
- Old bottles are still in the home.
- No one tracks supplements.
- A new symptom appeared after a medication change.
- The caregiver is unsure whether a dose was taken.
- Refills run out unexpectedly.
Reusable Product Asset Uses
This worksheet should eventually support:
- Printable PDF.
- Saveable worksheet.
- Calculator result add-on.
- Care Track step.
- Family summary export.
- Email or share version.
- Bring-this-to-a-tour version when relevant.
- Use-before-a-family-meeting version when relevant.
Professional Review
Recommended reviewer: pharmacist, clinician
Sources To Verify
Last reviewed: April 29, 2026.
Kefiw Worksheet Disclaimer
Kefiw provides educational care-planning tools, worksheets, and guides. These materials are designed to help families organize information and prepare better questions. They do not replace medical, legal, financial, tax, insurance, employment, benefits, or professional care advice. Care needs, costs, coverage, provider quality, eligibility, and legal requirements vary by person, plan, provider, state, and situation. For urgent medical concerns or immediate danger, call emergency services.
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Frequently asked questions
› How should families use this worksheet? How-to
Use it before a care decision, appointment, tour, provider interview, or family conversation so the discussion starts with facts instead of memory and stress.
› Is this worksheet professional advice? How-to
No. It organizes information and prepares better questions, but medical, legal, financial, tax, insurance, benefits, employment, and care decisions should be confirmed with qualified professionals.
› Should this be printed or saved? How-to
Both can help. A printed copy is useful during tours or family meetings, while a saved copy helps the family update the plan after care needs, costs, or safety risks change.
› How should I use this guide with a Kefiw tool? How-to
Use the guide as the plan and the linked Kefiw tool as the check. Read the steps first, try the move manually, then use the tool to compare outputs, catch edge cases, and decide whether the result actually fits your task.
› What mistake do tool guides help avoid? Troubleshooting
Tool guides help avoid using a utility mechanically without understanding what you are trying to accomplish. Most word, writing, and text utilities are fast, but speed can hide context mistakes. Know whether you are solving a puzzle, cleaning copy, drafting a line, or checking a rule.