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Medication List
ICR 202008-0923-001 · OMB 0923-0061 · Object 103629501.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Medication List |
| Author | CDC User |
| Last Modified By | Writer |
| File Modified | 2019-08-15 |
| File Created | 2026-10-17 |
| Conversion State | complete |
Extracted Text
Agency for Toxic Substances and Disease Registry
Pease Study
Medication List
Note: It is important to ask the participants to bring in all medications used regularly during the past two weeks before the office or the home visit for the physical measurements and blood draw. This includes both Over-the-Counter and Prescription Medications. These include pills, liquid medications, skin patches, eye drops, salves, inhalers and injections, as well as cold or allergy medications, herbal remedies, aspirin, ointments, vitamin supplements, Tylenol and Motrin are all examples. They could possibly affect the test and lab results.
1. Ask the participant about all medications, including over the counter, herbal remedies, fish oil, and vitamin or dietary supplements.
2. If the participant refuses to provide the medications or to allow you to record them, write “refused” on the Medication List and proceed to next step.
3. Provide dose (e.g. 50 mg), frequency (e.g. twice a day), and route (e.g. by mouth). Add lines as necessary.
4. Ask about any medications not visible at the office or the home visit, such as those needing refrigeration.