8600 Old Georgetown Road | Bethesda, MD 20814
301-896-3100

My Health and Medication Record:
Don't Leave Home Without It!

New! Click on the card to fill it out online and save it to your personal computer, smartphone or tablet.

Have you ever been asked for a list of medications and you weren’t able to remember every detail? Now it is easier than ever to carry your health information along with you.  Our handy "My Health and Medication Record" form has a place to list your medications, allergies, physicians, medical diagnoses and much more.

Suburban Hospital’s “My Health and Medication Record” is now available to download and save to your computer.  All you need to do is print out the information and take it to your next doctor’s appointment or hospital visit.  You can even save it to your smartphone.  You can also pick up a credit card sized version at the hospital to keep in your purse or wallet or we can send you one.

It's Easy to Organize Your Vital Information

"My Health and Medication Record" offers you (and each family member, too!) a convenient, organized record of your medications, dosages, allergies, and medical/surgical history. It also logs personal data and the names of an emergency contact and doctors.

As you fill it out, remember to include the names of any over-the-counter medications and herbal supplements that you take. These too can affect your medical care.

 

     

          

How to Get Your Card

"My Health and Medication Record" is available in our patient admission booklets and in public areas around the hospital. If you don’t see it, just ask! From outside the hospital, call 301-896-3939 and request that copies of "My Health and Medication Record" be mailed to your home. To print a copy at home, click here.   You can also fill it out online and download it to your personal computer using Adobe Reader.  If you have Adobe Pro, you can save and update the card each time your information changes.

With a completed "My Health and Medication Record," you can easily and accurately inform every healthcare provider you encounter, including hospital emergency rooms, physicians, outpatient clinics, outpatient radiology departments and others. Fill one out today for every member of your family!

Para descargar este formulario en español, haga clic aquí.

Other Helpful Information

Adobe Reader for PC (free)

Adobe Acrobat Pro for PC

Adobe Reader Mobile App (free for iOS and Android)

Tips for Using Medicines Safely