For Clinicians | Pediatric Dosing 101: What Parents Need From You Before They’re Dosing Alone

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Aaron Asay, PA-C, DMSc, FIBODM, FAWM

Pharmacy school drills one line into you over and over again: children are not small adults. A child’s body absorbs, distributes, and clears a drug on a different timeline than yours does, and the margin around a correct dose is narrower because there’s less child to absorb the error. That’s why every pediatric dose is calculated from weight instead of pulled off a standard adult label.

That’s complicated, but not too hard when a pharmacist or prescriber is just a phone call or message away for parents dosing their kids.  It’s a different problem at 9pm when nobody is reachable and a parent is reading a label written in mg/kg and only knows their child’s weight in pounds.

Today we are going to talk about appropriate medical preparation in children and how to help train parents with pediatric dosing at home. I’ve seen a lot of pediatric dosing errors in my years in practice and I want to help as much as I can to prevent these going forward, especially when information is limited for parents. 

Why children often need more drug per kilogram, not less

The elimination machinery grows up early, and glomerular filtration rate reaches adult levels by 8 to 12 months¹, so by the time a child is 2, the kidneys are clearing drugs roughly the way yours do. What stays different through the grade-school years is body composition and liver metabolism, because a higher share of a child’s weight is water, which spreads water-soluble drugs through a larger relative volume, and phase I metabolism runs above adult rates for some drugs through the first few years¹.

It feels backwards that per kilogram kids often need more than you do rather than less, but a 20 kg child on high-dose amoxicillin for an ear infection takes 1,800 mg a day² while an adult on 875 mg twice daily takes 1,750 mg, which means the 44 pound patient is taking more than the grown-up. That’s not always the case, since I used a high dose example, but it illustrates the point well. Parents round down because it feels safer, and a rounded-down antibiotic course won’t reach therapeutic levels. 

Pediatric dosing is weight-based, and the weight is in kilograms

Every pediatric dose starts from a number the parent usually doesn’t have: their child’s weight in kilograms. Medication doses are written in mg/kg while bathroom scales read pounds, and that conversion is the first place the dose goes wrong. Pounds divided by 2.2 gives kilograms, so a 40 pound child is 18 kg. A parent should be able to run that calculation themselves rather than guessing at it. A tired, sleep-deprived parent doing it at 1am on a phone calculator is introducing risk into the dosing, and they don’t have the clinician spidey sense that goes off when a result comes out too high or too low.

For a family that has a scale but a child who won’t hold still on it, the trick is subtraction: weigh the adult alone, weigh the adult holding the child, and the difference is the child’s weight. When nobody can weigh at all, the current APLS estimates are (age x 2) + 8 kilograms for ages 1 to 5 and (age x 3) + 7 for ages 6 to 12³, though both of them run low, so treat the result as a rough estimate rather than a real answer.

2 places the dose goes wrong after the math is right

If you hand a parent nine doses to measure, 84.4% will get at least one of them wrong, and one in five will be off by more than double on at least one⁴. That was 2,110 parents of children 8 and under, measuring in a study and under observation, with no sick kid howling on their shoulder and none of the sleep deprivation that comes with the real version of that night.

The units are the first of those two places, and here again they confuse parents: the ol’ mL versus teaspoon conundrum. Parents who think in teaspoons reach for a kitchen spoon 30% of the time, while parents who think in milliliters do it 1% of the time⁵, and dosing cups carry more than four times the odds of an error against an oral syringe⁴. Send an oral syringe home whenever you can. I know as a pharmacist I always gave them away for free from behind the counter when patients asked.

Concentration is the second place that errors can be introduced, and it’s the one a good syringe can’t rescue, because a dose in mg/kg gives you milligrams while the bottle is marked in milliliters, and the strength changes from bottle to bottle. Amoxicillin suspension is dispensed at 125, 200, 250, or 400 mg per 5 mL⁶, so the same 5 mL can be three times the dose depending on which bottle came home, and infant ibuprofen drops are double the concentration of the children’s suspension at 40 mg per mL against 20⁷, which matters in any house with a toddler and a second grader keeping both. A volume that worked last time only works again if the strength matches, so have parents read the concentration off the label every time, even on a refill of the same drug.

Accidental double doses to watch out for

Families unintentionally go over the 24-hour maximum in two ways. The first is that acetaminophen turns up inside products that don’t say Tylenol anywhere on the front, so a parent treating a fever with one bottle and a cough with another can give two full doses of the same drug in the same hour without ever seeing it happen. DayQuil and NyQuil Cold & Flu both carry it acetaminophen, as do Theraflu and Mucinex Fast-Max, along with the prescription pain combinations built on it, and ibuprofen hides the same way inside Advil Cold & Sinus and Advil PM.

The second way is simpler: when a parent alternates acetaminophen and ibuprofen through a long night and by midnight it can start to get confusing what went in when. I’ve found that in my own family, writing down the medication, the dose, and the time it was given keeps those long, tired nights clear.

What to send home before they need it

Everything above is executable at 1am only if the parent already has the pieces and basic know-how. Send them home with the child’s weight in kilograms written somewhere they’ll find it, an oral syringe, and the habit of checking the concentration on whatever bottle they’re holding, plus a written drug, dose, prescriber and pharmacy list for any child on daily medication. Parents can also put in Google 25lbs to kg and they can get an answer without having to do math themselves (or use it to double check their own math). Also this is obvious, but worth mentioning that obviously kids are growing, the weight at their physical 9 months ago, might not be accurate anymore! 

All of that assumes there’s something in the cabinet to measure, which is where the real gap sits: a family’s options are a reachable prescriber with an open pharmacy, or nothing, with no sanctioned middle where an age-appropriate formulation is already in the house at a strength that matches the child. Appropriate medical preparation is the name for that middle layer, and it’s what Jase builds for ages 2 through 11, with a licensed provider reviewing every request and writing the prescription. It’s for emergency use only, after first seeking the assistance of a qualified healthcare provider, and it’s in no way a replacement for the pediatrician who knows the child.

The bottom line

Pediatric dosing goes wrong a few ways in the translation and the math. The things parents need to succeed are: the weight in kilograms, an oral syringe, the concentration on the bottle in front of them and what their child’s dose clearly is (for Rx medications). If you’d rather not run it with every family, refer them to us and we’ll do the clinical work on the front end.

Sources

1. Merck Manual Professional Edition. Pharmacokinetics in Children. https://www.merckmanuals.com/professional/pediatrics/principles-of-drug-treatment-in-children/pharmacokinetics-in-children
2. American Academy of Pediatrics. The Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131(3):e964. High-dose amoxicillin 80 to 90 mg/kg/day in two divided doses. https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media
3. Advanced Life Support Group. Advanced Paediatric Life Support: The Practical Approach, 5th edition. Oxford: Blackwell, 2011. Formulas as described in Ali K, Sammy I, Nunes P. Is the APLS formula used to calculate weight-for-age applicable to a Trinidadian population? BMC Emergency Medicine. 2012;12:9. https://pmc.ncbi.nlm.nih.gov/articles/PMC3506443/
4. Yin HS, Parker RM, Sanders LM, et al. Liquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment. Pediatrics. 2016;138(4):e20160357. https://publications.aap.org/pediatrics/article-abstract/138/4/e20160357/52278/
5. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Spoon measurements contribute to many child drug-dosing errors. August 29, 2014. Describing Yin HS et al., Unit of Measurement Used and Parent Medication Dosing Errors, Pediatrics 2014. https://www.nichd.nih.gov/newsroom/releases/082914-podcast-pediatric-med-dosing
6. AMOXIL (amoxicillin) prescribing information. US Food and Drug Administration. Powder for oral suspension 125 mg/5 mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/50542s02950754s01950760s01950761s016lbl.pdf
7. Institute for Safe Medication Practices. Don’t Mix Up Concentrated “Ibuprofen Infant Drops” with “Children’s Ibuprofen.” https://www.consumermedsafety.org/safety-articles/dont-mix-up-concentrated-ibuprofen-infant-drops-with-childrens-ibuprofen

For Clinicians | What Is Plague? One Bacterium, Three Diseases

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Aaron Asay, PA-C, DMSc, FIBODM, FAWM

Well, the plague is back in the news. Reports out of Russia in early October said a worker at an anti-plague institute died of pneumonic plague after a purported lab accident.¹ Russian officials deny it, and the regional governor calls it pneumonia of unknown cause.²

As a pharmacist, I may not be your breaking news source. But, I remember the stories from history class of millions dying from the plague back in the Middle Ages.  It’s a great reminder of how little most of us know about plague since it has dropped out of everyday conversation for the last 200 years. That’s what this clinical refresher is about: one bacterium, that causes three types of illness

Why does one bacterium cause three diseases?

Yersinia pestis is the one bacterium, and where it takes hold in the body (skin, blood or lungs) decides which of three main clinical patterns you’re looking at.³ 

A flea bite drops it into the skin. It travels to the nearest lymph node and multiplies there, usually in the groin, armpit, or neck, and that node swells into a bubo.⁴ That’s bubonic plague, and it’s more than 8 in 10 US cases.⁵

When it takes hold in the bloodstream, it causes septicemic plague: fever, chills, extreme weakness, and shock characterize this variant.⁶ It can follow an untreated bubo, or it can come first, without the telltale node and with prominent nausea, vomiting, diarrhea, and abdominal pain.⁴ Yep, it can look like a stomach bug with a fever.

When it takes hold in the lungs, it’s called pneumonic plague, a pneumonia that gets bad fast, with cough, chest pain, and sometimes bloody sputum. Patients can become infected by breathingin droplets or particles from a person or animal with plague pneumonia, orby an untreated bubonic or septicemic infection which spreads there.⁶,⁷

Left untreated, plague can move from node to blood to lungs. The lung form is the only type  that can spread from person to person.⁶

When a patient has a sudden fever and a painful, swollen lymph node within about a week of flea or animal exposure, and lives in or recently visited the rural West, that’s the time to start thinking plague.⁴,⁶ Ask where they’ve been and what animals they’ve touched, including the family cat and anything they hunted or skinned.³,⁷ It is prime hunting season out here in Utah/Wyoming right now so this is particularly on my mind as I walk around neighborhoods and see every third house processing  their successful hunts in their driveway. 

Why doesn’t the lung form spread like the flu?

Pneumonic plague does spread from person to person. Like flu, it travels in respiratory droplets and exposure within about 6 feet can be catching.⁸,⁹ The difference is timing.

Flu is most contagious in the first few days of illness.⁸ Plague, like aging cheese, gets stronger with time. Transmission risk is minimal early, before the cough fully develops, and highest in the mid-to-late stages, when the patient is coughing up sputum loaded with bacteria.⁹,¹⁰ By then, the patient is usually too sick to be out and about, so the people at risk are the ones close enough to care for them.

Colorado saw this in 2014. A dog with pneumonic plague infected its owner and two veterinary staff. A fourth person, who handled the dog’s body and later spent extended close time with the owner while he coughed up bloody sputum, may have caught it from him. That was the first possible human-to-human spread in the US since Los Angeles nearly 100 years before in 1924.¹¹

Masks and distance stopped pneumonic plague outbreaks even before antibiotics were available,¹⁰ and they still protect you and your staff today. CDC doesn’t consider prophylaxis necessary for clinicians caring for these patients as long as standard and droplet precautions are upheld.¹² Prophylaxis is for people with close, sustained contact with a patient or animal with pneumonic plague who weren’t wearing adequate protective equipment, or with direct contact with infected fluids or tissue. The regimens are in CDC’s 2021 plague recommendations in MMWR.⁹,¹²

Why does timing decide survival?

Since plague is bacterial, antibiotics can be effective when treatment starts early. Before antibiotics, about 2 of every 3 US cases were fatal. Since then, it’s about 1 in 6.³

Untreated, plague keeps moving, from node to blood to lungs, and the odds get worse at each stop in the body. Even in the antibiotic era, septicemic and pneumonic plague kill more often than bubonic.³

At the pharmacy counter, if a patient presents with fever plus a painful node and describes  that exposure history, refer them to a prescriber immediately. Don’t give them acetaminophen for the fever and tell them to wait-and-see. In the office, call your local or state health department as soon as you suspect plague, and start treatment without waiting on test results.⁴,¹² Tell the lab you suspect plague because automated systems can misidentify Y. pestis, and in Colorado one called it a different bacterium for a week.⁴,¹¹

Who actually gets plague in the US?

Plague lives in wild rodents and their fleas across parts of the West, including prairie dogs, ground squirrels, chipmunks, and wood rats.⁷ People get it when they cross into that cycle: an infected flea bites a rodent, a cat that ate the infected rodent passes it to its owner, or someone handles or skins an infected animal.³,⁷ Wyoming’s 2021 pneumonic plague case likely traced to contact with sick pet cats.¹³ The US sees about 7 cases a year, mostly in rural New Mexico, Arizona, Colorado, and California.³,⁵

Even the worst case here, a traveler arriving with pneumonic plague, has a known response. Health officials trace close contacts, those contacts get prophylaxis or fever monitoring, and the care team uses droplet precautions.⁹,¹² That’s what happened in Colorado in 2014: officials traced 114 close contacts, recommended prophylaxis for 88, and no further cases turned up.¹¹

When a patient asks about the Russia story, in the office or at the pharmacy, here’s a short reply you can use: plague is a bacterial infection, it’s curable when treated early, and it’s rare here.

Then the prevention list:¹⁴

• Keep fleas off pets, get a sick pet to the vet quickly, and don’t let pets that roam outside sleep in the bed.
• Use insect repellent with DEET while outdoors.
• Wear gloves to handle or skin animals.
• Clear brush, rock piles, and woodpiles near the house, where rodents like to live.

If a sudden fever and a painful, swollen node show up, get seen fast and report where you’ve been.

The bottom line

Plague is very unlikely to touch your patients. It’s still a good reminder that illness doesn’t wait for a convenient time, and that a plan made ahead of time beats a scramble. That’s the work we do at Jase: helping people prepare for the times primary care isn’t available, in no way as a replacement for it. A licensed provider reviews every request before anything is prescribed, and our emergency kit medications are for use only in an emergency, after first seeking help from a qualified healthcare provider.

Sources

1. Meduza. Hospital in Russia’s Irkutsk region quarantined amid reports that a patient died of pneumonic plague. October 2, 2026. https://meduza.io/en/news/2026/10/02/hospital-in-russia-s-irkutsk-region-quarantined-amid-reports-that-a-patient-died-of-pneumonic-plague
2. Doubine S, Euronews Russian. Russia denies lab worker died of plague as quarantine in Siberia stays in place. Euronews. October 5, 2026. https://www.euronews.com/2026/10/05/situation-under-control-russian-authorities-reassure-public-after-plague-reports-in-siberi
3. Kugeler KJ, Staples JE, Hinckley AF, Gage KL, Mead PS. Epidemiology of human plague in the United States, 1900-2012. Emerg Infect Dis. 2015;21(1):16-22. https://wwwnc.cdc.gov/eid/article/21/1/14-0564_article
4. Centers for Disease Control and Prevention. Clinical Testing and Diagnosis for Plague. https://www.cdc.gov/plague/hcp/diagnosis-testing/index.html
5. Centers for Disease Control and Prevention. Plague: Maps and Statistics. https://www.cdc.gov/plague/maps-statistics/index.html
6. Centers for Disease Control and Prevention. Signs and Symptoms of Plague. https://www.cdc.gov/plague/signs-symptoms/index.html
7. Centers for Disease Control and Prevention. How Plague Spreads. https://www.cdc.gov/plague/causes/index.html
8. Centers for Disease Control and Prevention. How Flu Spreads. https://www.cdc.gov/flu/spread/index.html
9. Nelson CA, Meaney-Delman D, Fleck-Derderian S, Cooley KM, Yu PA, Mead PS. Antimicrobial treatment and prophylaxis of plague: recommendations for naturally acquired infections and bioterrorism response. MMWR Recomm Rep. 2021;70(3):1-27. https://www.cdc.gov/mmwr/volumes/70/rr/rr7003a1.htm
10. Kool JL. Risk of person-to-person transmission of pneumonic plague. Clin Infect Dis. 2005;40(8):1166-1172. https://pubmed.ncbi.nlm.nih.gov/15791518/
11. Runfola JK, House J, Miller L, et al. Outbreak of human pneumonic plague with dog-to-human and possible human-to-human transmission, Colorado, June-July 2014. MMWR Morb Mortal Wkly Rep. 2015;64(16):429-434. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6416a1.htm
12. Centers for Disease Control and Prevention. Clinical Care of Plague. https://www.cdc.gov/plague/hcp/clinical-care/index.html
13. Wyoming Department of Health. Wyoming Detects Rare Human Case of Pneumonic Plague. September 15, 2021. https://health.wyo.gov/wyoming-detects-rare-human-case-of-pneumonic-plague/
14. Centers for Disease Control and Prevention. Preventing Plague. https://www.cdc.gov/plague/prevention/index.html

For Clinicians | Medication List Accuracy: Nobody Has the Whole Picture Anymore

By Dr. Jamie Wilkey, PharmD, Director of Clinical Education
Medically reviewed and edited by Kristen Carpenter, PA-C

We’re closing out National Preparedness Month with the one step that costs nothing and that almost no patient has actually done: a medication record that’s correct.

As a pharmacist working in retail for many years, it became really clear to me that patients have a hard time keeping track of what they take. Especially polypharmacy patients, the ones on five or more medications. They don’t know all the drugs, the doses, who wrote those prescriptions, and sometimes even where they got it filled.

That’s not just a mess for the pharmacist trying to get a refill on the right medication. Deep down it’s a core problem for preparation and for healthcare in general. If there’s no one true source of what a patient is taking, in one place they can get to, it creates a ripple effect.

We are going to tackle this topic that seems simple, but is harder for your patients than you think. I’ll cover what patients actually bring us in the pharmacy, why no single record exists anymore, and how to work with a patient to start fixing it to get all of their medications in a record in one place.

What patients actually bring us

Ask a patient what they take and you’ll usually get the purpose, not the name. The blood pressure one. The thyroid one. The night blood sugar medicine. Not many know the full name, let alone the strength and the frequency. They get it from the pharmacist, put it in the organizer, and that’s the system.

When they do bring their medications in, it’s what we call brown bagging. A grocery bag on the counter, and we go through it vial by vial. They’re usually from different pharmacies and different doctors, and some aren’t being taken anymore. Just old vials still sitting in the house. Those vials are the only record that exists.

Then someone needs a transfer. They evacuated, or they’re traveling and out of refills. They hand me the bag as the pharmacist, or the handwritten note that says what everything is for but not what it is.It’s really hard to transfer a prescription I can’t identify (“your patient said they are taking a few medications for blood pressure and they need the one that is a red tablet sent over to us“), and I can’t call a prescriber about a medication I can’t name (“your patient said you gave them a pill last year for their mood. They need that refilled“).

How accurate are the lists patients do keep?

You might be thinking the patients who keep a list are fine. They aren’t.

In 138 patients at an urban emergency department in Australia, 75% of self-administered medication history forms had at least one discrepancy against a pharmacist-taken history, and 20% had at least one the authors judged high-risk ¹. In a US preoperative clinic, of 82 lists patients brought in themselves, 94% had at least one discrepancy against the clinic record, with a median of four per list ².

Both studies enrolled patients who produced a list at all. That’s the organized minority, the people who already did the thing we keep telling everyone to do. These numbers are the best case scenario. Yikes!

Nobody has the whole picture anymore

There used to be one record that tied it all together, and it was the insurance company because everything billed through them. Whatever pharmacy filled it, whichever doctor wrote it, all claims routed through the same company. That made the payer’s file the most comprehensive picture of what a patient was taking.

Now that behemoth that held everyone’s Rx history is coming apart. Patients frequently pay cash or use a discount card when it’s cheaper. They fill somewhere else because it’s faster. Some don’t want one company holding a list of everything they take and they intentionally fill for cash. Others don’t have insurance at all. And to add complexity to this, prescriptions start in more places now that there are so many new healthcare vertical companies with menopause from one service, weight loss from another, and mental health from a third. All on top of a primary care provider a patient already sees. 

So there’s no entity with the throughline anymore, and the patient became the record by default. We weren’t trained for this. Pharmacy school taught me a closed loop: one prescriber, one chart, one pharmacy that knew about both. That system is evaporating like a puddle on a hot summer day.

And before you assume your own office chart is the good copy: when researchers compared patient, GP, and community pharmacist records for 751 older patients in the Netherlands on an average of eight medications, the three sources disagreed for 71.9% of patients ³. There’s no correct copy for a patient to use or reference. Yikes!

The forms aren’t built to be patient-facing

So the patient is the walking medication record now. Nobody ever taught them how to do this, and the forms we hand them don’t help much.

Pull up any medication list template, the free federal one or whatever your clinic prints. They all start the same way: the name of the drug, and the strength. That’s what most just don’t know (especially those polypharmacy patients on 5+ medications). What they can tell you is that it’s the little white one for blood pressure.

So we hand someone a form that starts with the part they can’t do, and then we’re surprised when what comes back is wrong or half empty.

Here’s one thing you can use though. In that Australian study, the patients who left the pharmacy line blank had more than double the discrepancy rate, worse than patients on a long list of medications ¹. Tread carefully here…it predicts trouble, it doesn’t cause it. Filling the line in doesn’t make the rest of the list right. But a blank there tells you to slow down and ask more questions.

And to make matters worse, these patient-led records go stale fast. A patient fills one out in March, a specialist changes a dose in June, and nobody goes back to update it.

What actually works

Start with the one that already exists. Keep it simple!

If your patient is on Medicare Part D and meets the targeting criteria, their plan has to offer them a comprehensive medication review (CMR) every year, done by a pharmacist, at no cost to them ⁴. They walk out with a written summary in a standardized federal format, and that summary includes a personal medication list ⁵. I’ve done hundreds of these and they are fun. Most patients have never heard of them or think it is spam when a pharmacist calls them and offers to do one. 

When they don’t qualify for a CMR, or you want to do something today, print what you have. Have your MA pull the medication list off the chart and hand it over as a starting draft. Not a record. A draft. Make that clear it is just a springboard to start from because the minute a patient decides the office list is the authoritative one, they stop adding to it. And what’s missing from your chart is the whole point: the other prescribers, the cash fills, the online services, the supplements.

What the printout does is solve the naming of those medications. Your patient can’t write atorvastatin 40 milligrams from memory. They can absolutely correct a page that already says it and add “for cholesterol.” So they’re clear on how the name matches up with the indication

Then send them to their pharmacist with the bag. Brown bagging is helpful. In a randomized trial across three teaching hospitals in Colombia, a pharmacist-acquired history dropped the share of patients with at least one discrepancy from 93.6% to 60.7%⁶. A third better, and still wrong in six patients out of ten. That’s the ceiling, and it’s still the best we’ve got.

It’s also the only way an interaction check means anything, which we wrote about separately in The Drug Interactions You Create in an Emergency.

If you want a template to point them at, AHRQ’s is free, in English and Spanish, and it’s fine ⁷. No need to build your own.

This is what appropriate medical preparation looks like

Even in the best of times, when everything is working, it’s hard to help a patient nobody has a complete record for. In a disaster it compounds and makes everything worse.

The preparation that matters here is information, not inventory. A record the patient can actually get to, that says enough for someone else to act on it. None of this replaces primary care. Primary care is the bedrock for a patient building their Rx profile appropriately and accurately. 

That’s the work we do at Jase. We’re a team of physicians, physician assistants, and pharmacists, and we handle the clinical side ahead of time so a patient isn’t starting from zero when they can’t reach anyone. For the medications, patients complete an online intake for evaluation by a board-certified physician, which may include a live synchronous consult depending on their state. This record is a page your patient makes, and it’s the half of preparation we can’t do for them.

The bottom line

My grandma had this figured out on her own. She was on warfarin and knew how tricky that medication was with drug and food interactions. So she didn’t leave anything to chance. She typed her medications out on one page: the name, what it was for, the strength, the doctor who wrote it, and the pharmacy that filled it. Then she printed it and kept it in the kitchen, where someone (like an emergency responder) could easily and clearly find it.

Follow her great example! A simple Word document or the notes app works great. What it needs is to travel with the patient, to be findable by somebody else, and to have a date on it. Then update it once a year at the physical (at a minimum, and ideally whenever anything changes with their medications or supplements). It won’t be perfect. Even a pharmacist taking a full history doesn’t get it perfect. But a dated, mostly-right list that a stranger can find beats a grocery bag every time.

Sources

1. Wai A, Salib M, Aran S, Edwards J, Patanwala AE. Accuracy of patient self-administered medication history forms in the emergency department. American Journal of Emergency Medicine. 2020;38(1):50-54. Cross-sectional study, urban emergency department, Australia, 138 patients. https://pubmed.ncbi.nlm.nih.gov/31005394/
2. Lee KP, Nishimura K, Ngu B, Tieu L, Auerbach AD. Predictors of Completeness of Patients’ Self-reported Personal Medication Lists and Discrepancies With Clinic Medication Lists. Annals of Pharmacotherapy. 2014;48(2):168-177. Academic hospital preoperative clinic, 82 patient-brought lists, data collected January to October 2010. https://doi.org/10.1177/1060028013512109
3. Bosch-Lenders D, Stoffers HEJH, Winkens B, Twellaar M, Hufen WJM, et al. Discrepancies in prescribed medications as reported by patients, general practitioners, and community pharmacists in older patients with polypharmacy in primary care. BMC Primary Care. 2026. 751 patients across 24 general practices and 17 community pharmacies, the Netherlands. https://doi.org/10.1186/s12875-026-03332-3
4. Centers for Medicare and Medicaid Services. Medication Therapy Management. Part D sponsors must establish an MTM program, and programs may be delivered by pharmacists or other qualified providers. Contract year 2026 targeting criteria are described in the CY 2026 Medicare Advantage and Part D final rule fact sheet. https://www.cms.gov/medicare/coverage/prescription-drug-coverage-contracting/medication-therapy-management
5. Centers for Medicare and Medicaid Services. Medicare Part D Medication Therapy Management Program Standardized Format, frequently asked questions. Sponsors must at a minimum offer a comprehensive medication review annually to targeted beneficiaries, and the written summary provided to the beneficiary includes a Personal Medication List and a Medication Action Plan. https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/downloads/mtm-program-standardized-format-faqs-v08-1512-.pdf
6. Becerra-Camargo J, Martinez-Martinez F, Garcia-Jimenez E. A multicentre, double-blind, randomised, controlled, parallel-group study of the effectiveness of a pharmacist-acquired medication history in an emergency department. BMC Health Services Research. 2013;13:337. Three teaching hospitals in Bogota, Colombia, 242 patients completed. https://pmc.ncbi.nlm.nih.gov/articles/PMC3844415/