Alcohol, Medication and Older Adults
For Those Who Care About or Care for an Older Adult

Module 8: Preventing Misuse - Page 4 of 7

Medication Management Tools

The Medication Passport

Many pharmaceutical companies and public health agencies distribute small booklets, or passports, that help patients and their physicians track the use of both prescribed and over-the-counter medications. The patient brings the passport to each medical and dental appointment. The provider then records medications prescribed and instructions on how to use them properly.

Older persons should keep this passport or a small card listing their personal drug record in their possession at all times. In an emergency, this record could provide valuable information to medical personnel. In addition, there are guidelines that can help older adults understand and properly use medications.

MEDICATION PASSPORT
Name: _______________________________________________________
Address:  ___________________________________________________
Phone: ______________________________________________________
Doctor's Name: ______________________________________________
Phone: ______________________________________________________
Chronic Illnesses: __________________________________________
Allergies to drugs: _________________________________________       
(Repeat the information below for each drug taken) 
Drug Name: ___________________________________________________
Dose: ________________________________________________________
How to Take: _________________________________________________
Prescribed for: ______________________________________________
Date Started: ________________________________________________

Adobe Acrobat PDF IconA printable version (PDF) is available.
What is PDF?