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Medication Review - Patient Questionnaire

Dear Sir or Madam, if you have been admitted to the unit for at least 48 hours, please take a few minutes of your time to complete the following questionnaire.

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Medication Review - Patient Questionnaire (English)
1

What is your room number?

For example, Room 601
2

I have a good understanding of all medications that have been given to me during this current hospital admission.

Select one answer
3

What types of medications are you taking that you would you like more information about?

Select one or more answers
4

If you have a specific medication you would like more information about, please write below.

Ex. metoprolol

Thank you!

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