Become A Partner in Healthcare with The Med Form
Patients are the greatest source of medical information for doctors, nurses, pharmacists and other providers. You can play a vital role in your healthcare by providing your healthcare team with accurate information about medications and allergies.
It is extremely important to have an accurate medication record every time you see your healthcare provider. The Med Form, developed to enhance patient safety in Arizona, is available to record your medications and dosages. Simply click the link for the English or Spanish version and print your document. Please keep this record with you in case of an emergency.
On behalf of Yuma Regional Medical Center, thank you for taking an active role in your health and for improved patient care.
The Med Form (English Version)
La Forma de Med (Spanish Version)