Medication Reconciliation Form
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The Medication Reconciliation Form is designed to create an accurate, complete list of all medications a patient is currently taking. It captures prescription medications, over-the-counter drugs, vitamins, supplements, and herbal remedies -- each with dosage, frequency, route, prescribing physician, and how long the patient has been taking it.
Medication reconciliation is one of the most important safety processes in healthcare. Medication errors during transitions of care (hospital admission, discharge, referrals between providers) are a leading cause of preventable adverse events. This form provides a structured format that reduces errors by prompting patients to include medications they might otherwise forget to mention.
The template includes an adherence assessment section that identifies medications patients are not taking as prescribed, which is critical information for treatment planning. Pharmacy information and preferred pharmacy for new prescriptions are also captured. This form is required by Joint Commission standards and is essential for hospital admissions, discharge planning, post-hospitalization follow-up, and multi-provider care coordination.
What's included
- Prescription medication list with full details
- OTC, vitamin, and supplement documentation
- Medication allergy cross-reference
- Adherence assessment and barriers
- Pharmacy information and preferences
- Provider verification and signature
Who uses this template
- Hospital admission and discharge processes
- Transitions between care settings
- Multi-provider care coordination
- Annual medication review visits
All form fields
10 fields across 2 pages. Customize any field after signing up.
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