Mother’s illness inspires easy-to-use medication form

Posted on July 20, 2021 by Linda Ross

When she developed diabetic comorbidities, Elizabeth Fisch’s mother began to write out a list of her medications, making it easier for the hospital to process her when she arrived for treatment.

As her mother’s case became more complicated, Elizabeth, who is a member of the Paths to Wellness team, didn’t want to override her mother, but she grew concerned that nurses had never heard the generic names of some medications and wanted to make sure that everyone involved in her mother’s care was on the same page.

When she attended Carnegie Mellon University, Elizabeth studied art and minored in writing. Those talents helped her organize and design a form to chart in detail not only her mother’s medications, but also dosage and brand/generic names for each prescribed drug, where each medication was filled, and contact information (phone number, fax number, and street address) for doctors and others involved in her care.

“My mother was ill for many years,” Elizabeth explains. “I helped to sustain her. The form was really a godsend.” Sadly, her mother passed away two years ago.

Elizabeth also began using the form for herself, carrying one copy in her wallet and leaving one on the refrigerator at home, where emergency medical providers often look for health information. By reproducing the form, she was able to distribute the information in a readable, easy-to-understand format to hospitals and health care providers, including therapists and psychiatrists. She says that was important so all doctors knew what each other were prescribing.

“It’s very much appreciated by the medical staff,” Elizabeth notes. “It’s been welcomed everywhere.”

As a prescriber changes medications or dosages, Elizabeth is able to fax or mail the updated information to others involved in her care so they can be aware of any contraindications.

On the back, she provided space to write down any questions there might be for a primary care physician, psychiatrist, or other doctor.

Elizabeth photocopies the form seven times with each update to keep all providers in the loop. She maintains one master copy in pencil that she updates any time there is a change.

Although she developed the form nine years ago, she has changed the design when warranted. For instance, she added date of birth and allergies, which providers often need. Click here for form.