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My Health & Medication Record

Keep your medical information, including a list of medications, with you.

Keeping track of medications, allergies and medical history can be difficult, especially as medications change.  At Suburban, we want you to be prepared for your doctor's visit and any other time when you might need all of your medical information in one place.

Suburban Hospital’s My Health and Medication Record lets you digitally store an 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.You can email it to your doctor or print out a copy for a variety of needs. 

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.

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

Just click the image on the right for a downloadable PDF.
Para descargar este formulario en español, haga clic aquí