Medication Reconciliation Worksheet
Track every prescription, OTC medication, and supplement — with dosage, prescribing doctor, pharmacy, and refill dates — to catch conflicts before they cause harm.
Medication errors send nearly 100,000 older adults to the emergency room every year — and most of those errors happen during transitions: hospital to home, one doctor to another, one pharmacy to another. This worksheet helps you create a single, complete medication list and reconcile it against previous lists to catch discrepancies, duplicates, and dangerous interactions.
⚠️ Important Safety Note
Never stop, start, or change a medication without consulting the prescribing doctor. This worksheet identifies issues to discuss — it does not replace clinical judgment.
Complete Medication List
Date completed: _______________ Completed by: _______________
| Medication Name (Brand & Generic) | Dose | Frequency | Route | Prescribing Doctor | Pharmacy | Refill By | Purpose (Why taken) | Status N/C/S |
|---|---|---|---|---|---|---|---|---|
Status: N = New since last review | C = Continued, no change | S = Stopped (should no longer be taken)
Over-the-Counter Medications & Supplements
Include pain relievers, allergy meds, sleep aids, vitamins, herbal products, and any other non-prescription products.
Allergies & Adverse Reactions
Medication Action Plan
After reconciliation, list each issue found and the action to take:
How to Complete This Worksheet
Step 1: Gather Everything
Collect EVERY medication, supplement, and over-the-counter product your parent takes. Empty every medicine cabinet, nightstand drawer, and pill bottle stash. Include: prescription medications, over-the-counter drugs (pain relievers, allergy meds, antacids, sleep aids), vitamins and supplements (including herbal products), eye drops, inhalers, patches, creams, and injections. Don't assume anything is 'not important' — list it all.
Step 2: Complete the Medication Table
For each medication, fill in every column: drug name (brand and generic), dose (mg/mcg), frequency, route (by mouth, injection, patch, etc.), prescribing doctor, pharmacy, refill date, and purpose. The 'purpose' column is critically important — many older adults take medications and don't know why. If you're not sure what something is for, look it up or ask the pharmacist.
Step 3: Identify Changes
Compare this list to the previous medication list (from before the last hospital stay, or from the last doctor visit). Mark each medication as: NEW (just started), CONTINUED (no change), CHANGED (different dose or frequency), or STOPPED (should no longer be taken). This is the reconciliation step — catching discrepancies here is the whole point.
Step 4: Check for Conflicts
Review the completed list with your parent's pharmacist or primary care provider. Ask specifically: are any of these medications duplicates (same drug prescribed by different doctors under different names)? Are there any known interactions between these medications? Is your parent on any medications that are considered potentially inappropriate for older adults (the Beers List)? Are any medications being prescribed to treat side effects of other medications (a 'prescribing cascade')?
Step 5: Create a Medication Action Plan
Based on the reconciliation: which medications should be continued exactly as prescribed? Which need a dose adjustment? Which should be discontinued? Which need lab monitoring (blood thinners, certain diabetes meds, some antibiotics)? Write down the specific action for each medication and who is responsible — doctor, pharmacist, family member, or coordinator.
Step 6: Set Up a Management System
Choose a system your parent can actually use: pill organizer (weekly or monthly), blister packs from the pharmacy (pre-sorted by dose time), automated medication dispenser with alarms, or pharmacy synchronization (all refills on the same day each month). What works on paper and what your parent will actually follow may be different — pick what fits their routine.
Pharmacy Contacts
Disclaimer: This worksheet is an organizational tool for tracking medications and facilitating conversations with healthcare providers. It does not provide medical advice, diagnosis, or treatment recommendations. Always consult the prescribing doctor or a licensed pharmacist before making any changes to medications. American Healthcare Coordination does not provide medication advice or clinical pharmacy services.
Provided by American Healthcare Coordination, LLC | www.americanhealthcarecoordination.com