My Medication List – 360° SCD Hub

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My Medications List

Medications List

Use this form to add all of your medications here to be able keep track of them, in case you needed to share this with your care provider or family member.

Name of Medication

Hydroxyurea

ACE Inhibitors

Adakveo (crizanlizumab-tmca)

Aspirin

Azithromycin

Acetaminophen (Tylenol)

Codeine

Corticosteroids

Droxia

Endari (L-glutamine oral powder)

Fentanyl

Folic Acid

Hydromorphone

Ibuprofen

Morphine

Oxbryta (voxelotor)

Penicillin

Siklos

Voxelotor

Other

Does your care provider want you to take this medicine indefinitely?

Yes

No

I’m not sure

What other medication would you like to add?

Dosage Amount (how many units per dose)

Doasage Unit Type

Milligram (mg)

microgram (mcg)

Gram (g)

Millilitre/Cubic Centimetre (ml)/(cc)

Teaspooon (tsp)

Tablespoon (tbsp)

Other

What other dosage would you like to add?

Frequency

Once a day

Twice a day

3 times a day

4 times a day

As needed only

Other

Prescription Start Date

MM slash DD slash YYYY

Prescription End Date

MM slash DD slash YYYY

My Medication List

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My Medication List

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