HealthRX.com · Printable medication review sheet
Rybelsus caregiver morning routine and review sheet
Use this sheet with an older adult who takes Rybelsus. Fill in the current label details, gather what to bring, record each morning routine, and take the questions to the prescriber or pharmacist.
Person and current Rybelsus prescription
Copy these details from the current label and pharmacy bottle.
Name of person taking RybelsusFull name as on the prescription
Prescriber name and phoneDoctor or nurse practitioner who writes the prescription
Pharmacy name and phonePharmacy that fills the tablets
Tablet strength on the labelWrite the strength printed on the carton or bottle
Schedule printed on the labelCopy the day ranges and tablet strengths exactly as printed
Other morning medicinesList every pill, capsule or liquid taken by mouth in the morning
Insulin or sulfonylurea takenWrite the names, or write none
Gather before the visit
Bring these to the prescriber or pharmacist visit.
- Bring the current Rybelsus carton and the label it came with.
- Confirm the strength and schedule printed on the label match the bottle.
- List all other oral medicines taken in the morning and their times.
- Note any vomiting, diarrhea or poor fluid intake in the past two weeks.
- Write any trouble swallowing whole tablets with water.
- Check with the pharmacist whether any new medicine was added recently.
- Bring a list of recent blood sugar readings if they are being kept.
- Note any planned surgery, dental work or procedure with sedation.
Daily morning routine record
Record each morning. Note any missed tablet and what was done.
| Date | Tablet given | Water measured | Wait finished | Notes |
|---|---|---|---|---|
Questions for the prescriber or pharmacist
- Does the schedule printed on this label apply to this person?
- What should we do if a morning dose is missed?
- Which other morning medicines need a wait after this tablet?
- Should kidney function be checked if vomiting or diarrhea starts?
- Is a lower dose of insulin or sulfonylurea needed with this tablet?
- Which signs of pancreatitis should we report to you right away?
- What can be done if swallowing the tablet whole is difficult?
- Should the surgeon or dentist be told about this medicine before a procedure?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.