Allergy and Current Medication Form Template
The allergy and medication form is an excerpt of the medical history, made for a quick check before each procedure. While the full medical history can be taken once, this form is read and updated at every session, because that is where the changes that affect safety show up: a new anticoagulant, a recent allergy, an antibiotic course in progress.
Combine this template with the medical history form and the contraindication acknowledgment statement.
Why this check matters
| Information | Why it matters |
|---|---|
| Anticoagulants and antiplatelets | May increase the risk of bruising |
| Anti-inflammatories and supplements | Some change bleeding |
| Anesthetic or latex allergy | Defines what to use and what to avoid |
| Reaction to injectable products | Guides the choice and monitoring |
| Corticosteroids and immunosuppressants | May alter healing and response |
| Ongoing antibiotic or infection | May call for postponing |
| Recent isotretinoin | Requires assessing the approach |
Form template
How to lead the conversation
Ask open before closed: "What medicines do you take, even the ones that seem small?" works better than "Do you take medication?". Ask the patient to bring the boxes or a photo of the prescription. Often the important item surfaces only when they see the name on the packaging.
When something is concerning, do not decide in a hurry. A single medication rarely settles the question; what counts is the patient as a whole, the procedure and the risk. For an overview, see anticoagulants and injectable procedures.
Records and privacy
The form is part of the patient chart and contains health information. Store it with restricted access, avoid photographing it and sending it through apps unnecessarily, and follow the LGPD (Brazil's data protection law). If it is digital, use a password and access control.
A good routine
Keep the form at the top of the patient chart, with the date of the last update clearly visible. Before each session, the front desk can send a message reminding the patient to bring their medication list. On the day, the professional checks item by item, signs and only then prepares the material. That minute of attention is one of the simplest and most effective safety measures in patient care.
Frequently asked questions
Why ask about supplements and herbal remedies?
Some can affect bleeding or clotting and go unnoticed in the medical history. Asking specifically, including about vitamins and teas, prevents the patient from leaving them out because they do not think of them as medicine.
Should the patient stop a medication before the procedure?
Not on their own. No medication should be stopped without guidance from whoever prescribed it. The professional assesses the risk and, if necessary, talks to the patient's physician.
Do I need an allergy test before a procedure?
It depends on the product and on the professional's approach. The form records the history of reactions; the decision on testing follows clinical judgment and each product's instructions for use.
How often should the form be updated?
At every session, asking what has changed. Medications and health conditions change, and an old form can give false reassurance.