HealthRX.com · Printable training log
Zepbound caregiver injection training and weekly record
Use this sheet with a caregiver of an older adult starting or continuing Zepbound. Fill in the presentation and training details, bring the checklist to the visit, and record each weekly injection and any missed dose.
Prescription and training details
Write what is on the label or pharmacy bag. Ask if anything is unclear.
Presentation in handVial, single-dose pen or KwikPen
Dose currently prescribedCopy exactly as written on the label
Prescriber name and phone
Pharmacist name and phone
Caregiver name
Person who gave training and date
Usual weekly injection dayWrite the day of the week
Before the first injection
Bring this list to the training visit.
- Confirm which presentation the pharmacy will supply
- Ask the trainer to show the exact device in hand
- Write down the steps the trainer demonstrates
- Confirm whether the caregiver or patient will inject
- Check with the prescriber whether self-injection is appropriate
- Note any visual limits that affect use of the KwikPen
- Confirm the upper arm site is injected by another person
- Bring the Instructions for Use for the presentation in hand
- Confirm where to dispose of used needles and pens
Weekly injection record
Write one row per injection. Note any missed or late dose and what was decided.
| Date | Site used | Given by | Missed or late? | Notes |
|---|---|---|---|---|
Questions to ask at the visit
- What should we do if a weekly dose is missed?
- How late can a missed dose still be given?
- If we change the weekly day, what gap must be kept between doses?
- Which vomiting or diarrhea signs should we report, and to whom?
- Should we watch for dizziness or low blood pressure when standing?
- Do other medicines need a dose review because of this injection?
- How should used pens and needles be disposed of at home?
- Who should we call before any planned surgery or 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.