Medication Schedule for Substance Use Disorder Treatment

Patient Information

Name: _________________________ Date: __________________________

Daily Medication Schedule

Morning Medications (6:00 AM - 9:00 AM)

• Medication 1: _________________ Dose: _____ Time: _____
• Medication 2: _________________ Dose: _____ Time: _____

Afternoon Medications (12:00 PM - 3:00 PM)

• Medication 1: _________________ Dose: _____ Time: _____
• Medication 2: _________________ Dose: _____ Time: _____

Evening Medications (6:00 PM - 9:00 PM)

• Medication 1: _________________ Dose: _____ Time: _____
• Medication 2: _________________ Dose: _____ Time: _____

Important Guidelines

Medication Safety

• Take medications exactly as prescribed
• Do not skip doses or adjust dosage without consulting your healthcare provider
• Store medications in a secure, dry place away from children
• Do not share medications with others

Emergency Contacts

Prescribing Provider: _____________________ Phone: _________________________________ Emergency Services: 911 Poison Control: 1-800-222-1222

Weekly Progress Tracking

Week of: ________________

_Patient Signature: _____________________ Date: _____________________ Provider Signature: _____________________ Date: _____________________