Your local pharmacy is working to prevent and control antibiotic resistance

Information about me

Name

Insurance ID

How old are you?

Information about my pharmacy and doctorPharmacy contact details

Doctor contact details

About your antibiotic record card• Your antibiotic record card keeps

a list of antibiotics you have taken, what they were taken for and whether they were effective

• Your antibiotic record card helps your doctor decide whether antibiotics are the right medicine for you when you are ill

• Your antibiotic record card reminds your pharmacist what antibiotics you have taken

• Your pharmacist will use the information on your antibiotic record card to talk with you about the antibiotics they give you

My antibioticrecord card

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes noWrite down the side effects:

Your pharmacist will advise you whether you should take antibiotics with or without food

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes noWrite down the side effects:

Speak to you pharmacist if you experience side effects

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes noWrite down the side effects:

Make sure you complete your course of antibiotics

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes noWrite down the side effects:

Speak to your pharmacist if you have concerns about taking your antibiotics

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes noWrite down the side effects:

Your pharmacist will advise you whether you should take antibiotics with or without food

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes noWrite down the side effects:

Speak to you pharmacist if you experience side effects

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes noWrite down the side effects:

Make sure you complete your course of antibiotics

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes noWrite down the side effects:

Speak to your pharmacist if you have concerns about taking your antibiotics

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic

Your local pharmacy is working to prevent and control antibiotic resistance

Information about me

Name

Insurance ID

How old are you?

Information about my pharmacy and doctorPharmacy contact details

Doctor contact details

About your antibiotic record card• Your antibiotic record card keeps

a list of antibiotics you have taken, what they were taken for and whether they were effective

• Your antibiotic record card helps your doctor decide whether antibiotics are the right medicine for you when you are ill

• Your antibiotic record card reminds your pharmacist what antibiotics you have taken

• Your pharmacist will use the information on your antibiotic record card to talk with you about the antibiotics they give you

My antibioticrecord card

Your local pharmacy is working to prevent and control antibiotic resistance

Information about me

Name

Insurance ID

How old are you?

Information about my pharmacy and doctorPharmacy contact details

Doctor contact details

About your antibiotic record card• Your antibiotic record card keeps

a list of antibiotics you have taken, what they were taken for and whether they were effective

• Your antibiotic record card helps your doctor decide whether antibiotics are the right medicine for you when you are ill

• Your antibiotic record card reminds your pharmacist what antibiotics you have taken

• Your pharmacist will use the information on your antibiotic record card to talk with you about the antibiotics they give you

My antibioticrecord card

Your local pharmacy is working to prevent and control antibiotic resistance

Information about me

Name

Insurance ID

How old are you?

Information about my pharmacy and doctorPharmacy contact details

Doctor contact details

About your antibiotic record card• Your antibiotic record card keeps

a list of antibiotics you have taken, what they were taken for and whether they were effective

• Your antibiotic record card helps your doctor decide whether antibiotics are the right medicine for you when you are ill

• Your antibiotic record card reminds your pharmacist what antibiotics you have taken

• Your pharmacist will use the information on your antibiotic record card to talk with you about the antibiotics they give you

My antibioticrecord card

Turn over.6Fold down the middle once more.

5

Fold down the middle to enclose the inner panels of the card.

4Fold down the middle, leaving the printed side of the paper visible.

3

Start with the printed side facing away from you.

2Your printed page looks like this.1

Folding instructionsAntibiotic record card

Your local pharmacy is working to prevent and control antibiotic resistance

My antibioticrecord card

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes noWrite down the side effects:

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic

Information about my antibioticsHow long did it take you to feel better?Write down the number of days it took you to feel better:

Did you have any side effects?Please tick: yes Write down the side effects:

To be completed by your pharmacistDate

Condition

Name and brand of antibiotic