The Connecticut Department of Public Health is working with partners including the Connecticut Hospital Association (CHA), the CHREF Patient Safety Organization, Qualidigm, and the Qualidigm PSO to promote awareness of patient safety strategies and empower patients to be more active partners in their care. As the first step in this statewide effort to engage patients in safety, we have developed a wallet medication card in order to assist consumers in maintaining an accurate record of the medicines they take and other important information. It is critical that your healthcare providers have complete information about your medical history and current medications, and we encourage all consumers to use the wallet medication card or a similar tool to track this information.


The wallet medication card and instructions are available in two formats by clicking on the links below. The first format (PDF) is for consumers who will print the card and complete it by hand. The second format (Word) is for consumers who would like to download the card as a Microsoft Word document and save it to their own computer for filling out electronically before printing.


Click here for Wallet Medication Card (PDF version)

Click here for Wallet Medication Card (Word Version)