Notebook entry
What I heard
- What the doctor thinks may be wrong, or my health question: ____________________
- Exact medicine discussed, and how it is taken (pill, shot, cream): ____________________
- Approved or compounded: ____________________
- Reason this option was discussed: ____________________
- Other options named: ____________________
Notebook entry
Who is responsible
- Full name of the doctor or nurse: ____________________
- Virginia licence checked: ____________________
- Pharmacy’s full name: ____________________
- Virginia pharmacy record checked: ____________________
- How to reach them with questions later: ____________________
Notebook entry
What happens next
- Tests or records requested: ____________________
- What result changes the plan: ____________________
- What problem needs quick help: ____________________
- Date of the next check-up or test: ____________________
- Full cost each month: ____________________