A Customizable Guide for Tracking Your Parkinson's Medications
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Name: _________________________ Date: _________________________ Neurologist: ___________________
| Time | Medication | Dosage | With Food? |
|---|---|---|---|
| Carbidopa/Levodopa | □ Yes □ No | ||
| Rasagiline | □ Yes □ No | ||
| Other: _________ | □ Yes □ No |
| Time | Medication | Dosage | With Food? |
|---|---|---|---|
| Carbidopa/Levodopa | □ Yes □ No | ||
| Entacapone | □ Yes □ No | ||
| Other: _________ | □ Yes □ No |
| Time | Medication | Dosage | With Food? |
|---|---|---|---|
| Carbidopa/Levodopa | □ Yes □ No | ||
| Pramipexole | □ Yes □ No | ||
| Other: _________ | □ Yes □ No |
Neurologist: ____________________ Pharmacy: ______________________ Emergency Contact: _____________
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