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The Med Form is a collaborative effort of the Arizona Hospital and Healthcare Association’s (AzHHA’s) Safe & Sound patient safety initiative, Arizona Medical Association (ArMA), Arizona Partnership for Implementing Patient Safety (APIPS), and Health Services Advisory Group (HSAG). All of these organizations are located in
Phoenix,
Arizona,
USA
The Med Form helps patients and their family members track medications they are taking, from prescription to over-the-counter medicines such as herbals and vitamins. This form is designed to provide physicians, hospitals, pharmacists, home health agencies, and others with a current list of all of a patient's medicines. By sharing The Med Form with providers, patients become active participants in the health care team.
The Med Form:
- Helps patients and their family members remember all of the medications the patient is taking;
- Provides the patient's doctor(s) and other health care providers with a current list of all medicines, including over-the-counter medicines such as vitamins and herbals;
- Detects concerns about medicines by including a comprehensive listing of medications for the patient's health care team; and
- Serves as the patient's “voice” in an emergency — a communication tool with paramedics, emergency room staff, and all other heath care providers.
Background
The Med Form was developed to address the concerns expressed by health care providers when trying to reconcile patient’s medications and not having accurate or complete information.
With the goal of developing a universal communication tool for the whole state of Arizona to use, this tool was developed and designed through a collaborative process with up to 40 different health care organizations, including hospitals, physicians, health plans, associations, consumers, pharmacies, home health agencies, and others.
Once the first draft of the form was developed it was presented to several consumer focus groups (non-health care individuals) and asked, “Would you use this?” Based on feedback, modifications were made and the final version was developed in both English and Spanish. Within the first month of launching The Med Form, 100,000 forms have been distributed for use by hospitals on discharge, physicians during visits, community health fairs, and unique situations such as the Hurricane Katrina evacuees that arrived in Arizona.
Directions
The Med Form is available in both English and Spanish as a downloadable .PDF from The Med Form website (www.themedform.com).
Here are some easy instructions for patients to follow when using The Med Form:
- Keep The Med Form with you at all times, in case of a medical emergency.
- Take The Med Form with you to all doctor and other health care provider visits (e.g., nurse practitioner or dietitian).
- Write down all of the medicines you are taking, including over-the-counter medications such as vitamins, herbals, and others.
- Include the name of the doctor who prescribed the medication. You may also write why you are taking the medicine (e.g., high blood pressure, high blood sugar, high cholesterol). If you are not sure why you are taking the medication please write "don't know."
- When you are discharged from the hospital, someone will speak with you about which medicines to take and which medicines to stop taking. Because patient medications often are changed during hospitalization, it's important that you complete a new Med Form. Take the new form to all doctor visits following your hospitalization to discuss it with him or her.
- Remember to update your Med Form when your doctor changes, stops, or updates your medication.
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