Medication History Form - UW Medicine 2026

1. Click ‘Get Form’ to open the Medication History Form in the editor.
2. Begin by entering the date at the top of the form. This helps to keep your records organized.
3. Fill in your patient name in the designated field to ensure proper identification.
4. In the Allergies section, list any known allergies. If there are none, check the box provided.
5. Indicate if you react to latex or rubber by answering the question with a simple 'Yes' or 'No'.
6. For female patients, answer questions regarding pregnancy and breastfeeding by checking 'Yes' or 'No' as applicable.
7. In the Current Medications section, list all prescription drugs. If none, check the appropriate box.
8. Provide details such as strength and directions for each medication listed, along with the prescribing provider's name.
9. Repeat step 7 and 8 for Over-the-Counter Medications and Herbs, Vitamins, Minerals sections as needed.

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