Dose LogFree to print
Medication record for home use
When more than one person helps with someone's medicines, a shared record stops doses being given twice or not at all. Write in each medicine and time, then initial the box when a dose is given.
How to use it
- Copy each medicine, its strength and dose, and the time from the label or the pharmacy's instructions. One line per time: a medicine taken morning and evening gets two lines.
- When a dose is given, write your initials in that day's box.
- Write S if it was skipped and R if it was refused, and add a note on the back with why.
- Keep the record with the medicines, and start a new month on a new sheet.
Days 1 to 16
| Medicine and dose | Time | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Days 17 to 31
| Medicine and dose | Time | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Who gave it
| Initials | Name | Phone |
|---|---|---|
Keeping it useful
- Change the record only when the prescription or the pharmacy's instructions change, and date the change.
- Bring it to appointments and medication reviews: it shows what was given, not what was meant to be.
- Ask the doctor or pharmacist about anything you're not sure of. This record doesn't tell anyone what to give.
Also free: a medicine list and a wallet medicine card for the person you look after.
This page helps you keep track; it isn't medical advice. Ask your doctor or pharmacist about your own medicines. Reviewed 5 November 2026.