HealthRX.com · Printable training log
Mounjaro caregiver injection training and weekly dose record
Use this sheet when a family member or caregiver will give the weekly Mounjaro injection at home. Fill it in before the first home injection, bring it to the prescriber or pharmacist, and keep it updated with each weekly injection, site used and any missed or moved day.
Patient, caregiver and prescriber details
Write these before the first training session.
Patient full nameAs it appears on the prescription
Caregiver full namePerson who will give the injection
Prescribed presentationVial, prefilled single-dose pen or single-patient-use KwikPen
Prescriber name and clinic
Pharmacy name
Other diabetes medicines takenInsulin or sulfonylurea names, if any
Before and during caregiver training
Tick each item once it is done.
- Confirm the exact Mounjaro presentation prescribed and write it on this sheet.
- Bring the Instructions for Use for that presentation to the training session.
- Ask the trainer to show the injection technique for the caregiver, not only the patient.
- Note whether the patient has visual impairment, since the label does not recommend KwikPen self-administration for those people.
- Check with the pharmacist how to store the pen or vial and how to dispose of used needles.
- Write down where the caregiver will inject, including the back of the upper arm if another person gives the injection.
- Note the weekly injection day that the patient and caregiver agree on.
- Bring this sheet and any glucose readings to the next prescriber visit.
Questions for the prescriber or pharmacist
- What should the caregiver do if a weekly injection is missed and the window to give it has passed?
- Which signs of dehydration should the caregiver report straight away?
- Should the dose of insulin or the sulfonylurea be reduced when Mounjaro is started?
- Which low blood sugar signs should the caregiver watch for, and what should they do?
- How often will kidney function be checked during dose increases?
- Who should be told before any planned surgery or procedure that needs anesthesia or sedation?
- What stomach symptoms should prompt a call to the clinic before the next visit?
- Can the weekly injection day be moved, and how much notice is needed?
Weekly injection and site record
Write one line for each weekly injection. Record missed or moved days in the notes column.
| Date | Site used | Given by | Stomach or other symptoms | Notes |
|---|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.