NOTES
My Health Care Team
Doctor ____________________ Phone ___________
Nurse ____________________ Phone ___________
Hospital __________________
Main Number ___________
Other ____________________
Phone ____________
Emergency Contacts
________________________ Phone ____________
________________________ Phone ____________
Other Medications I Am Taking
___________________________________________
___________________________________________
Thalidomide Dosing Schedule
Dose (eg, 100 mg)________________________________
Number of Capsules (eg, 2 x 50 mg)________________
Schedule: Morning___ Every Other Day___ Other___
Important Reminders When Taking Thalidomide
___________________________________________
___________________________________________
___________________________________________
Appointments
Date
Time
Important Notes

---