Medication review – Demo clinic

Named GP (if known):

Do you have any concerns or side effects from your medication?

Yes

No

Please specify:

Are you taking medication to control your blood pressure?

Yes

No

Blood pressure

Please provide us with the last 3 blood pressure readings you have taken at home.

For a list of validated home blood pressure monitors, visit www.bihsoc.org/bp-monitors or discuss with your pharmacy.

Day 1

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Day 2

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Day 3

Systolic “Higher”

Diastolic “Lower”

Heart Rate

Do you know when and how to take your medication?

Yes

No

Please speak to a Pharmacist or a GP to discuss when and how you should take your medication.

How are you feeling?

On a scale of 1 being “sad, depressed or down”, 5 being “not happy or sad” or 10 being “happy, awesome, great”

Are you happy for the doctor to update your review date now?

Yes

No

Terms and conditions

I confirm that this is not an emergency and understand the surgery cannot help while it is closed. If I need help right now, I will use the NHS 111 service. In an emergency, I will call 999 or go to A&E.