Printable checklist
Appointment one-pager
Bring this to every doctor visit. It saves time, prevents medication errors, and shows the team that someone is paying attention. Print, fill in once, update when anything changes.
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Patient info
Full name and date of birth
AllergiesMedications and other, including any reactions.
Current diagnosesList all, with year diagnosed if known.
Recent hospitalizations (date, where, why)
Medications
Update the day anything changes. The most common cause of medication errors is providers working from old lists.
Medication nameGeneric and brand if both used.
Dose and frequencye.g., "10mg, twice daily with food."
Prescribing doctor
What it’s for
Date started
Over-the-counter meds & supplementsThese interact too, list them.
Providers
Primary care doctorName, practice, phone.
SpecialistsList each, what they treat, phone.
PharmacyName, location, phone.
Preferred hospital
Before this visit
Fill these in the night before the appointment.
Three questions I want to ask (in priority order)
Patterns I’ve noticed since last visitMood, sleep, appetite, falls, anything new.
Symptoms to reportWhen did they start? How often? What triggers them?
Anything that’s changed (meds, providers, conditions)
During the visit
Take notes (or ask permission to record)
Ask: "Is there anything I should watch for before the next visit?"
Confirm next steps, meds, follow-ups, when to callRepeat back if you’re not sure.
Get a written after-visit summary
After the visit
Update the medication list if anything changed
Note the next appointment date
Update pill organizer if doses changed
Share key updates with other caregivers / family
This checklist is general guidance, not legal, medical, or financial advice. Verify specifics with the relevant professionals.
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